By Marjorie MacDonald, RN, MSc, PhD
In 2002, the BC Ministry of Health began a process of public health (PH) system renewal in the province, beginning with the development of a Core Public Health Functions framework which, along with new PH Legislation, was to be the centre piece of the renewal process. The framework was released in 2005, comprising: (1) 21 core public health programs in the areas of health improvement, prevention, environmental health, and health emergency management; (2) four public health strategies including health promotion, health protection, preventive interventions, and health assessment/disease surveillance; (3) an equity and a population lens to ensure the needs of particular population groups were met; and (4) system capacity and infrastructure elements to support implementation, including research, PH information systems, legislation, training, planning, and performance management.
The Core Public Health Functions Research Initiative (CPHFRI), initiated by Marjorie MacDonald and Trevor Hancock, engaged partners and stakeholders from all the health authorities and other organizations across the province in an integrated knowledge translation process to conduct research on core functions framework implementation. With MSFHR Team Planning and Team Start-Up infrastructure funding, CPHFRI partners collaboratively developed a framework for a research agenda that specified a time-ordered set of research priorities and four cross- cutting themes (Knowledge Translation, Health Equity, Partnerships, and Methodological Development). These themes are reflected to some degree in each of our research projects.
The over arching goals of CPHFRI were to: renew public health systems and services in BC and Canada; contribute to methodological development of approaches to studying complex adaptive systems; train public and population health researchers in a range of PH disciplines; contribute to evidence-informed practice and PH practice improvement; improve the health of the population and reduce health inequities. These goals were subsumed under Marjorie MacDonald’s Applied Public Health Chair Research Award (now complete) titled
Public Health Education and Population Health Intervention Research and were reflected in the goals of the flagship research program under CPHFRI – the Renewal of Public Health Systems (RePHS). RePHS explored the implementation and impact of two core PH programs (Healthy Living and STI prevention) along with the contextual influences on implementation.
We also examined: the integration of an equity lens in the two core programs; the PH human resource issues in these programs including the competencies necessary to implement the CF framework; and the nature of collaboration between public health and primary care. We used several new (to PH) and innovative methodologies consistent with a complexity science perspective in answering our research questions. These included situational analysis to map contextual influences on implementation, concept mapping to explore applications of evidence and equity, and we plan to exploit the strengths of NVIVO qualitative software through the query function to examine the complex inter-relationships among all the influences on implementation. To date, several papers have been published on the REPHS findings and many more are in progress.
CPHFRI has now completed two MSFHR grants, and eight CIHR grants, including: two infrastructure grants, one Knowledge to Action operating grant, one Population Health Intervention Research grant, two Knowledge Synthesis grants, one Knowledge Translation Supplement grant, two Meeting, Planning and Dissemination grants, and one programmatic Emerging Team Grant. We also have three current and ongoing research projects: two Knowledge Synthesis grants (one a realist synthesis and one a meta-narrative synthesis) and one five year Programmatic Grant in the Pathways to Health Equity initiative – the Equity Lens in Public Health, led by Bernie Pauly (NPI), Marjorie MacDonald (PI), Trevor Hancock (PI), and Warren O’Briain (Principle Knowledge User).
Our accomplishments to date include:
• Since its inception in 2006, CPHFRI has garnered close to $6M in peer-reviewed funding.
• All of our initial research priorities identified in a 2007 think tank have been funded.
• The following core programs have been examined in one or more CPHFRI studies: Unintentional Injury Prevention, Healthy Living, Chronic Disease Prevention, Food Safety, Food Security, Core Programs that include a Sexually Transmitted Infection prevention component, Mental Health Promotion, and Preventing the Harms of Substance Use.
• Many successful CPHFRI trainees: six undergraduate RAs, six masters level internships or scholarships, six PhD internships or scholarships, three post-doctoral fellowships plus several others just starting.
• Policy and practitioner level engagement in the research process and paper writing.
Most recently, we have gone through a re-visioning process for CPHFRI in which we renamed ourselves Research in Public Health Systems and Services (RePHSS, taking over the RePHS logo) and held a Think Tank in 2014 to develop a new set of research priorities and update our research agenda. We are working with Dr. Glen Mays of the US National Public Health Services and Systems Research Centre on a proposal for a cross-national study to advance PHSSR in Canada.
From the 2015 Fall Communiqué — Public Health
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