Exploring health equity integration among health service and delivery systems in Nova Scotia: perspectives of health system partners.

IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH International Journal for Equity in Health Pub Date : 2024-08-26 DOI:10.1186/s12939-024-02256-7
Joshua Yusuf, Ninoshka J D'Souza, Hilary A T Caldwell, Sarah Meaghan Sim, Mark Embrett, Sara F L Kirk
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Abstract

Background: Achieving health equity is important to improve population health; however, health equity is not typically well defined, integrated, or measured within health service and delivery systems. To improve population health, it is necessary to understand barriers and facilitators to health equity integration within health service and delivery systems. This study aimed to explore health equity integration among health systems workers and identify key barriers and facilitators to implementing health equity strategies within the health service and delivery system in Nova Scotia, ahead of the release of a Health Equity Framework, focused on addressing inequities within publicly funded institutions.

Methods: Purposive sampling was used to recruit individuals working on health equity initiatives including those in high-level leadership positions within the Nova Scotia health system. Individual interviews and a joint interview session were conducted. Topics of discussion included current integration of health equity through existing strategies and perceptions within participant roles. The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis, with interviews transcribed and deductively analyzed in NVivo. Qualitative description was employed to describe study findings as barriers and facilitators to health equity integration.

Results: Eleven individual interviews and one joint interview (n = 5 participants) were conducted, a total of 16 participants. Half (n = 8) of the participants were High-level Leaders (i.e., manager or higher) within the health system. We found that existing strategies within the health system were inadequate to address inequities, and variation in the use of indicators of health equity was indicative of a lack of health equity integration. Applying the CFIR allowed us to identify barriers to and facilitators of health equity integration, with the power of legislation to implement a Health Equity Framework, alongside the value of partnerships and engagement both being seen as key facilitators to support health equity integration. Barriers to health equity integration included inadequate resources devoted to health equity work, a lack of diversity among senior system leaders and concerns that existing efforts to integrate health equity were siloed.

Conclusion: Our findings suggest that health equity integration needs to be prioritized within the health service and delivery system within Nova Scotia and identifies possible strategies for implementation. Appropriate measures, resources and partnerships need to be put in place to support health equity integration following the introduction of the Health Equity Framework, which was viewed as a key driver for action. Greater diversity within health system leadership was also identified as an important strategy to support integration. Our findings have implications for other jurisdictions seeking to advance health equity across health service and delivery systems.

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探索新斯科舍省卫生服务和提供系统之间的卫生公平整合:卫生系统合作伙伴的观点。
背景:实现健康公平对改善人口健康非常重要;然而,健康公平通常没有在医疗服务和交付系统中得到很好的定义、整合或衡量。为了改善人口健康,有必要了解在医疗服务和交付系统中整合健康公平的障碍和促进因素。本研究旨在探讨卫生系统工作人员之间的卫生公平整合问题,并确定在新斯科舍省卫生服务和提供系统内实施卫生公平战略的主要障碍和促进因素,在卫生公平框架发布之前,重点解决公共资助机构内的不公平问题:方法:采用有目的的抽样调查,招募从事健康公平倡议工作的人员,包括在新斯科舍省卫生系统中担任高级领导职务的人员。进行了个别访谈和联合访谈。讨论的主题包括目前通过现有战略整合健康公平的情况以及参与者角色的看法。实施研究综合框架(CFIR)用于指导编码和分析,访谈内容在 NVivo 中进行转录和演绎分析。研究采用定性描述的方法,将研究结果描述为健康公平整合的障碍和促进因素:共进行了 11 次个别访谈和 1 次联合访谈(n = 5 名参与者),共有 16 名参与者。半数参与者(n = 8)是卫生系统中的高层领导(即经理或以上级别)。我们发现,医疗系统内的现有策略不足以解决不公平问题,而在使用健康公平指标方面的差异表明缺乏健康公平整合。通过应用 "健康公平框架",我们确定了实现健康公平整合的障碍和促进因素,其中,实施 "健康公平框架 "的立法权以及伙伴关系和参与的价值都被视为支持健康公平整合的关键促进因素。健康公平整合的障碍包括用于健康公平工作的资源不足,系统高层领导缺乏多样性,以及对现有健康公平整合工作各自为政的担忧:我们的研究结果表明,需要在新斯科舍省的医疗服务和提供系统中优先考虑健康公平整合问题,并确定了可能的实施策略。在引入 "健康公平框架"(Health Equity Framework)之后,需要采取适当的措施、资源和合作关系来支持健康公平整合,该框架被视为行动的关键驱动力。卫生系统领导层的更大多样性也被认为是支持整合的一项重要战略。我们的研究结果对其他寻求在医疗服务和提供系统中推进健康公平的辖区具有借鉴意义。
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来源期刊
CiteScore
7.80
自引率
4.20%
发文量
162
审稿时长
28 weeks
期刊介绍: International Journal for Equity in Health is an Open Access, peer-reviewed, online journal presenting evidence relevant to the search for, and attainment of, equity in health across and within countries. International Journal for Equity in Health aims to improve the understanding of issues that influence the health of populations. This includes the discussion of political, policy-related, economic, social and health services-related influences, particularly with regard to systematic differences in distributions of one or more aspects of health in population groups defined demographically, geographically, or socially.
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