Inter-organisational partnerships are widely used approaches in public health and chronic disease prevention (CDP), and may include organisations from different sectors, such as research-policypractice sectors, inter-governmental sectors, or public and private sectors. While multiple conceptual frameworks related to multi-sectoral partnerships exist, they do not reflect the interactions among key factors that influence the performance of partnerships, including those involving public-private partners for CDP. Using system mapping, this project sought to propose potential linkages among factors that influence multi-sectoral partnerships through blending insights from conceptual frameworks with the experiences of a government agency involved in brokering multi-sectoral partnerships for CDP.
There are tradeoffs in knowledge synthesis – for example, between comprehensiveness and timeliness, between generalisability and policy relevance. The tradeoffs are particularly challenging for public health. A growing international community is grappling with building more relevant and useful knowledge bases, to facilitate use of this knowledge in policy and practice. These questions guided a knowledge synthesis using a novel 'rapid review' methodology. The synthesis used complex adaptive systems as a theoretical lens, in collaboration with an international expert panel. Findings strengthen the call for a systems paradigm in public health, extending theoretical propositions to empirical studies of knowledge generation and use.
This paper aims to provide public health organisations involved in chronic disease prevention with conceptual and practical guidance for developing contextually sensitive knowledge-to-action (KTA) strategies. Methods involve an analysis of 13 relevant conceptual KTA frameworks, and a review of three case examples of organisations with active KTA agendas. From this analysis, this paper identifies and discusses four key principles for enhancing organisational KTA strategy: (1) align knowledge production and action; (2) foster connections among relevant stakeholders; (3) understand and work with key contextual factors; and (4) consider a diverse yet coherent set of KTA activities.
Population and public health research has been shifting from describing factors that shape health to an interrogation of the processes and outcomes underpinning policy and programme interventions. This shift has given rise to acknowledging population health intervention research (PHIR) as a distinct field of study in Canada. Given that PHIR aims to maximise the use of evidence to inform interventions, a discussion paper was written and a workshop was held, with 24 participants working across policy, practice and research, to identify distinct features of PHIR that create opportunities and challenges for knowledge translation (KT). Building on the discussion paper and activities at the workshop, workshop participants surfaced five features of PHIR that need specific consideration to facilitate progress on understanding and capitalising on the relationships between KT and PHIR. Implications for stakeholders interested in maximising the use of evidence to inform strategies for chronic disease prevention are also provided.
Incremental approaches to introducing change in Canada's health systems have not sufficiently improved the quality of services and outcomes. Further progress requires 'large system transformation', considered to be the systematic effort to generate coordinated change across organisations sharing a common vision and goal. This essay draws on ongoing dialogue relating to transformation, and examines transformative efforts in the Saskatchewan health system. We aim to build a shared understanding of systems thinking in the context of transformation, and to outline examples of how systems thinking perspectives, with an emphasis on the role of evidence, may inform strategy for complex change initiatives.
Abstract Preventing chronic diseases, such as cancer, cardiovascular disease and diabetes, requires complex interventions, involving multi-component and multi-level efforts that are tailored to the contexts in which they are delivered. Despite an increasing number of complex interventions in public health, many fail to be 'scaled up'. This study aimed to increase understanding of how and under what conditions complex public health interventions may be scaled up to benefit more people and populations. A realist synthesis was conducted and discussed at an in-person workshop involving practitioners responsible for scaling up activities. Realist approaches view causality through the linkages between changes in contexts (C) that activate mechanisms (M), leading to specific outcomes (O) (CMO configurations). To focus this review, three cases of complex interventions that had been successfully scaled up were included: Vibrant Communities, Youth Build USA and Pathways to Education. A search strategy of published and grey literature related to each case was developed, involving searches of relevant databases and nominations from experts. Data extracted from included documents were classified according to CMO configurations within strategic themes. Findings were compared and contrasted with guidance from diffusion theory, and interpreted with knowledge users to identify practical implications and potential directions for future research. Four core mechanisms were identified, namely awareness, commitment, confidence and trust. These mechanisms were activated within two broad scaling up strategies, those of renewing and regenerating, and documenting success. Within each strategy, specific actions to change contexts included building partnerships, conducting evaluations, engaging political support and adapting funding models. These modified contexts triggered the identified mechanisms, leading to a range of scaling up outcomes, such as commitment of new communities, changes in relevant legislation, or agreements with new funding partners. This synthesis applies and advances theory, realist methods and the practice of scaling up complex interventions. Practitioners may benefit from a number of coordinated efforts, including conducting or commissioning evaluations at strategic moments, mobilising local and political support through relevant partnerships, and promoting ongoing knowledge exchange in peer learning networks. Action research studies guided by these findings, and studies on knowledge translation for realist syntheses are promising future directions.
OBJECTIVES: The aim of the Population Health Intervention Research Initiative for Canada (PHIRIC) is to build capacity to increase the quantity, quality and use of population health intervention research. But what capacity is required, and how should capacity be created? There may be relevant lessons from the Canadian Heart Health Initiative (CHHI), a 20-year initiative (1986-2006) that was groundbreaking in its attempt to bring together researchers and public health leaders (from government and non-government organizations) to jointly plan, conduct and act on relevant evidence. The present study focused on what enabled and constrained the ability to fund, conduct and use science in the CHHI. METHODS: Guided by a provisional capacity-building framework, a two-step methodology was used: a CHHI document analysis followed by consultation with CHHI leaders to refine and confirm emerging findings. RESULTS: A few well-positioned, visionary people conceived of the CHHI as a long-term, coherent initiative that would have impact, and they then created an environment to enable this to become reality. To achieve the vision, capacity was needed to a) align science (research and evaluation) with public health policy and program priorities, including the capacity to study "natural experiments" and b) build meaningful partnerships within and across sectors. CONCLUSION: There is now an opportunity to apply lessons from the CHHI in planning PHIRIC.
