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Renewal of Public Health Systems (RePHS)

CIHR Team in Public Health Services

Principal Investigator: Marjorie MacDonald
Principal Decision Maker: Trevor Hancock
Co-investigators
(listed alphabetically):
Allan Best, Ted Bruce, Maureen Dobbins, George Eisler, Anne George, Anita Kothari, Craig Mitton, Linda O'Mara, Bernadette Pauly, Michael Pennock, Sandra Regan, Barb Riley, Esther Sangster-Gormley, Ruta Valaitis, Joan Wharf Higgins, Sabrina Wong
Decision Making Partners: Cindy Anderson, Charlene Beynon, Gayle Bursey, Meghan Day, Karen Dickenson, Sandra Dimini, Vera Etches, Vicki Farrally, Michelle Haavaldsrud, Orhan Hassan, Shazia Karmali, Heather Manson, Daina Mueller, Veronic Ouellette, Amanda Parks, Nancy Peroff-Johnston, Paulina Salamo, Jennifer Scarr, Lorna Storbakken, Karen Strange, Joanne Thanos, Carol Timmings, Claire Warren, Roger Wheeler
Advisory Board Members: Janet Braunstein Moody, Stephen Corber, Richard Massé, Gregory Taylor, Jane Underwood
Funder: Canadian Institutes of Health Research (CIHR)
Funding Period: January 2009 – January 2014

The purpose of this program of research is to do a set of comparative studies on the implementation and impact of the BC Core Public Health Functions framework and the Ontario Public Health Standards through an integrated program of research that partners academic researchers and key decision makers at the provincial and regional/local levels. Our overarching goals are to contribute to: a) Public health systems renewal in BC and Ontario to inform system renewal in Canada and, in turn, contribute to improving population health and reducing health inequities; b) advancing the field of public health services research in Canada by implementing a consensus-based research agenda and applying/developing innovative research methodologies; c) informing integration and linkage of public/population health and primary care services; and d) training expert public health services and population health researchers. The specific objectives of our program of research are:

1. To explore and understand the core public health functions implementation process and the contextual factors influencing it in BC and Ontario.
2. To examine and understand the impact and outcomes of core public health functions implementation at organizational, systems, and population levels in both BC and Ontario.
3. To explore the implications of core functions implementation for public health human resources planning related to workforce competency, skill development, and basic and continuing education.
4. To apply and contribute to the development of new, innovative and appropriate methods for: a) mapping the context of Core Function implementation, b) identifying the complex causal processes that link core function implementation to outcomes, and c) analyzing and describing the relationships and collaborations between primary care and public health practitioners and systems.
5. To assess the nature and extent to which an equity lens has been integrated into core functions policies and programs in BC and Ontario and to critically analyze the application of an equity lens in relation to the reduction of inequities drawing on previously developed analytic tools.
6. To engage in an innovative knowledge translation and exchange (KTE) process to strengthen and improve services and their linkage with other health services in BC and Ontario.

We will achieve our research objectives by conducting an integrated set of studies that are focused on two core public health programs common to both BC and Ontario. These include: chronic disease prevention/healthy living and preventing sexually transmitted infections/harm reduction. In keeping with a systems and ecological framework guiding our project, and using an embedded case study, multi-method design, two overarching questions will be addressed:

1. What are the processes of public health standards/core functions implementation for two core public health programs in BC and ON, and how do contextual variations within and between each province affect the implementation processes?
2. What are the impacts and outcomes of the two core programs and how does variation in context and process of implementation affect these?

Furthermore, the following cross-cutting themes will be examined within the research questions:

1. What are the implications of public health systems renewal for public health human resources planning related to workforce competency, skill development, and for basic and continuing education?
2. What are the relationships between public health and primary care sections within and across the three core programs and what effects do these relationships have?
3. How and to what extent is an equity lens integrated into the three core programs and with what impact?

Our assembled team includes leaders and experts recognized in both provinces, and nationally, including public health senior decision-makers and researchers at multiple universities. Each team member brings unique knowledge and expertise to the table, and collectively has extensive experience in health services and policy research, public and population health research, studies exploring the implementation and outcomes of population and policy interventions, as well as knowledge translation/exchange research. This diversity of disciplines and the team’s affiliations with four universities provides excellent opportunities for research training and mentoring. Team members are at various career stages and include experienced and promising new researchers.

Methodology
The overarching theoretical perspective for our program of research is complex adaptive systems theory, which highlights the centrality of context in understanding the implementation and impact of complex public health systems interventions. In keeping with our systems perspective, the research questions are conceptualized within a case study design, in which the case is defined as the core public health program. A case study design serves descriptive, interpretive and explanatory intents and is useful when “how” and “why” questions are being posed and when there is little opportunity to control events. Such designs allow for quantitative and qualitative data collection at individual, group, organizational, social and political levels – consistent with ecological and systems perspectives, thus contextual influences on public health interventions and phenomena can be captured. Methods and process will be determined collaboratively for each study. The main data collection and analyses strategies include: focus groups, key informant interviews, document reviews, secondary data analysis, concept mapping, and social network analysis.

Timeline
This is a five year project. The initial research team meeting took place December 3, 2008. A project launch took place in BC in 2009, and more recently in Ontario (Spring 2010). The focus of the launches was to discuss team membership and leadership, research questions, methods and timelines with a view to moving toward consensus and a finalized and more detailed research plan. Please check back soon for more details as the project moves forward.

Contact
For more information about this grant please contact Diane Allan, (dallan@uvic.ca) RePHS Project Coordinator.


Overview of RePHS
To watch an overview of RePHS in video format click here.

BC September 22 and 29 2011 Webinars
September 22 2011 webinar
September 29 2011 webinar

BC and Ontario Overview of Phase 1 Results
BC Lessons Learned
Ontario Overview


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