Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Doctor of Philosophy

Program

Health Information Science

Supervisor

Dr. Anita Kothari

2nd Supervisor

Dr. Marlene Janzen Le Ber

Abstract

Abstract

Background:

The Locally Driven Collaborative Project (LDCP) funded health equity indicators are an evidence-based tool designed to be used as an internal assessment tool to guide Ontario Local Public Health Agencies (LPHA) in the delivery of equitable programme and services. The aim of this realist evaluation was to explore the factors that enable each LPHA to implement the indicators in order to internally examine the extent to which they were working towards health equity.

Methods:

A realist evaluation of the health equity indicators was conducted to answer the following questions: What mechanism(s) enable or hinder the implementation of the health equity indicators into LPHAs’ practice? What are the reasonings and responses that are triggered within the organization as a result of integrating these resources into a specific context? What outcomes are generated throughout the process? Data collection to inform the realist evaluation cycle was done in three stages: (a) nascent programme theories generated through a rapid realist review of existing literature, (b) initial programme theories generated through secondary analysis of data collected through a pilot case study of the indicators, and a realist focus group with six individuals involved with the development of the indicators, and (c) refined programme theories informed through two rounds of realist interviews with 22 public health practitioners from 17 LPHAs across Ontario.

Results:

A total of three refined programme theories were generated and supported by six context-mechanism-outcome configurations. These programme theories provide insight into the importance of organizational leadership support needed for the implementation of health equity indicators. This support is materialized through the allocation of monetary resources and staff time to address health inequities experienced by the local population. It is also critical to integrate health equity as a foundational organizational value and develop/maintain working partnerships with other organizations and priority populations. The mechanisms triggered within these contexts enhance the implementation of the health equity indicators at the LPHA’s level.

Conclusion:

The use of realist evaluation to explore questions related to the implementation of health equity indicators is novel. The findings from this realist evaluation provide insight regarding what about the health equity indicators works, and under what circumstances. These programme theories, and their corresponding Context Mechanism Outcome Configurations (CMOCs) can assist organizations to prepare for the implementation of the health equity indicators, which require different contextual factors that trigger specific mechanisms, and generate particular outcomes for specific actors. Finally, this realist evaluation contributes to the emerging and vibrant dialogue around the implementation of ‘equity’ as a core value in health, but more specifically in public health.

Summary for Lay Audience

Background:

The LDCP funded health equity indicators are an evidence-based tool designed to be used as an internal assessment tool that guides Ontario Local Public Health Agencies (LPHA). The purpose of this evaluation was to understand how these indicators were implemented by LPHAs across Ontario.

Methods:

A realist evaluation of the health equity indicators was conducted to answer the following questions: What social triggers allow or hinder the implementation of the indicators into LPHAs’ practice? What outcomes are generated throughout the process? Data collection to inform the evaluation cycle was done in three stages: (a) nascent programme theories generated through a review of existing literature, (b) initial programme theories generated through secondary analysis of data collected through a pilot case study of the indicators, and a focus group with six individuals involved with the development of the indicators, and (c) refined programme theories informed through two rounds of interviews with 22 public health practitioners from 17 LPHAs across Ontario.

Results:

A total of three refined programme theories were generated and supported by six context-mechanism-outcome configurations. These programme theories provide insight into the importance of organizational leadership support needed for the implementation of health equity indicators. This support is materialized through the allocation of monetary resources and staff time to address health inequities experienced by the local population. It is also critical to integrate health equity as a foundational organizational value and develop/maintain working partnerships with other organizations and priority populations. The social factors triggered within these contexts enhance the implementation of the health equity indicators at the LPHA’s level.

Conclusion:

The use of this type of evaluation method to explore questions related to the implementation of health equity indicators is novel. The findings from this evaluation provide insight regarding what about the health equity indicators works, and under what circumstances.

Available for download on Tuesday, August 31, 2021

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