Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy


Health and Rehabilitation Sciences


Kothari, Anita R.


This dissertation presents three studies that, collectively, seek to contribute to our understanding of the practice of implementation policymaking grounded in the experience of the practitioner. Herein, policymaking is conceptualized as a shared set of practices enacted by actors purposefully engaged in collective performances. This thesis makes important contributions to the iterative processes of theorizing by advancing knowledge about local policymaking practices in the following ways: 1) creation of the Knowledge Enactment in Practice Settings (KEPS) framework as a guide to assist in the exploration of knowledge-based practices including the co-creation of context; 2) use of new insights informed by the KEPS tool to examine and re-examine existing expectations around collaboration and local governance in implementation policymaking; and 3) a more substantial and nuanced understanding of the experience of decision makers practicing together within co-created settings.

In the first of the three papers, an interpretive synthesis included 35 studies that examined local policymaking to create representations of the types and sources of information and knowledge used, and key knowledge-based roles and activities. Based on this synthesis, an original framework (KEPS) was created. The KEPS framework depicted different aspects of the collective knowledge work of local policymakers which are explored in the following papers. The second paper explored the co-creation of practice in a lead-agency dominated setting within a multi-level implementation project in the Province of Ontario. The experience of dominance and the potential for a culture of inequality as well as the importance of balance, flexibility and the development of trust for collaboration are discussed. In the third paper, an exploration of how engaged actors function within the practice setting described in the previous paper highlighted the role of power, resources and hierarchical accountability as well as the importance of meaningful engagement. Together, the three studies demonstrated the use of the KEPS framework in the exploration of knowledge enactment settings. Use of the KEPS framework supports the development of a more nuanced understanding of how engaged, local actors experience practice and highlights the need for greater awareness of the ongoing co-creation of practice settings.

Summary for Lay Audience

Policy, once made, is not likely to be applied exactly as written. The application of high-level policy, like provincial or federal, in local community settings is a complicated and often messy process. This dissertation presents three related studies that set out to improve our understanding of the experiences of people who participate in the processes of applying high-level policy in local-level projects. This thesis contributes in the area of policymaking by: 1) presenting a new framework to help us explore the processes of decision making; 2) using what we learn to re-examine what think we know from studies already published in the literature and 3) developing a better and more detailed understanding of local decision making that reflects the perspectives and experience of decision makers themselves.

The first of the three studies was a review paper that collected information from 35 published studies to try and represent the types and sources of information and knowledge used in local policymaking, as well as to describe the kinds of roles and activities performed by local decision makers. The Knowledge Enactment in Practice Settings (KEPS) framework was created based on the results. In the next two papers, this framework was used to explore: 1) the ways in which decision makers worked together to define how and where they practiced decision-making and 2) then I explored the experiences of decision makers as they performed within the project they had helped to define. By studying each of these things separately, I found that inclusion and meaningful engagement were very important in the experience of local decision makers and that these features are influenced by rigid project structures and processes that may be adopted from a powerful lead agency. Overall, use of the KEPS framework highlighted the importance of understanding how project processes and structures are defined in finding pragmatic ways to support the meaningful engagement of decision makers.

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Health Policy Commons