By Marjorie MacDonald and Bernie Pauly
There have been many calls over the past 15 years to renew and strengthen public health systems in Canada. In BC, the Framework for Core Functions in Public Health was introduced in 2005 as a public health policy intervention. At the same time, the Core Public Health Functions Research Initiative (CPHFRI) was formed to study the implementation and impact of the core functions framework. Today the core functions framework is part of the guiding framework for public health and our research team has grown to include six health authorities in BC, six health units in Ontario, the BC Ministry of Health, the Public Health Agency of Canada, the National Collaborating Centre for the Determinants of Health, the BC Public Health Association, Public Health Ontario, UNBC, McMaster and Western universities.
As a result of our initial work on implementation of public and population health interventions, the team identified the need for a better understanding of why some public health interventions are successfully implemented and others are not. While traditional systematic reviews have been conducted on effective implementation in health care there have been few in public health so their relevance to public health is unclear.
In most reviews, stringent inclusion criteria have excluded entire bodies of evidence that may be relevant for policy makers, program planners, and practitioners to understand implementation in the unique public health context. In 2014, our team spanning two provinces was successful in receiving CIHR funding to conduct a realist synthesis of the implementation of public health interventions. Realist synthesis is a theory-driven methodology that draws on diverse data from different study designs to explain how and why observed outcomes occur in different contexts and thus may be more appropriate for public health. In other words, what works, for whom, and under what conditions does it work?
In undertaking this realist synthesis our first challenge was to find a program theory that would guide our work. While there are
implementation frameworks for health care, they are not necessarily reflective of or suited to public health. So, after a review of implementation theories and frameworks, we developed an initial program theory, adapted for public health from the Consolidated Framework for Implementation Research, to explain the implementation outcomes of public health interventions within particular contexts. One of
the goals of our work is to refine this initial theory into a ‘final’ realist program theory that explains important context-mechanism-outcome configurations in the successful implementation of public health interventions.
This knowledge is important to evidence based public health. First, developing new public health interventions is costly and policy windows that support their implementation can be short lived. Second, ineffective implementation wastes scarce resources and is neither affordable nor sustainable. Third, public health interventions that are not implemented will not have their intended effects on improving population health and promoting health equity. Understanding the factors that affect whether or not a public health intervention is implemented can contribute to improvements in public health.
We gratefully acknowledge the Canadian Institute of Health Research for funding to support this project and
the entire team for their contributions. For a description of the research protocol, see MacDonald, M., Pauly, B.,
Wong, G., Schick-Makaroff, van Roode, T., Wilson Strosher, H., Kothari, A., Valaitis, R., O, Briain, W. Manson, H.,
Carroll, S., Tong, S., Lee, V., Dickenson-Smith, K., Ward, M. (in press). Supporting Successful Implementation of
Public Health Interventions: Protocol for a Realist Synthesis. Systematic Reviews.
From the 2016 Spring Communiqué — Knowledge Synthesis
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