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BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Determinants of an integrated public health approach: the implementation process of Greenland’s second public health program

Authors: Christine Ingemann, Barbara J. Regeer, Christina V. L. Larsen

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

Greenland struggles with a high prevalence of smoking, alcohol and drug abuse. In response to the increasing need for preventive initiatives, the first public health program Inuuneritta was introduced in 2007. Internationally, frameworks focus primarily on the implementation of a single, well-described intervention or program. However, with the increasing need and emergence of more holistic, integrated approaches, a need for research investigating the process of policy implementation from launch to action arises. This paper aims to augment the empirical evidence on the implementation of integrated health promotion programs within a governmental setting using the case of Inuuneritta II. In this study, the constraining and enabling determinants of the implementation processes within and across levels and sectors were examined.

Methods

Qualitative methods with a transdisciplinary approach were applied. Data collection consisted of six phases with different qualitative methods applied to gain a comprehensive overview and understanding of Inuuneritta II’s implementation process. These methods included: observations and focus group discussions at the community health worker (CHW) conference, telephone interviews, document analysis, and a workshop on results dissemination.

Results

Enabling determinants influencing the implementation process of Inuuneritta II positively were high motivation among adopters, local prevention committees supporting community health workers, and the initiation of the central prevention committee. In contrast, constraining determinants were ambiguous program aims, high turnovers, siloed budgets and work environments, and an inconsistent and neglected central prevention committee.

Conclusion

Inuuneritta II provided a substantial framework for an integrated health policy approach. However, having a holistic and comprehensive program enabling an integrated approach is not sufficient. Inuuneritta II’s integrated approach does not harmonise with the government’s inflexible organisational structure resulting in insufficient implementation.
Appendix
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Literature
1.
Bjerregaard P, Stensgaard T. Greenland. In: Young K, Bjerregaard P, editors. Health Transition in Arctic Populations. Canada: Heinemann; 2008. p. 23–38.
2.
Niclasen B, Mulvad G. Health care and health care delivery in Greenland. Int J Circumpolar Health. 2010;69(5):437–87.CrossRefPubMed
3.
Naalakkersuisut. In: Health Mo, editor. Inuuneritta-Folkesundhedsprogram, Landsstyrets strategier og målsætninger for folkesundheden 2007–2012 [Public Health Programme, strategies and goals from 2007 to 2012]. Nuuk: Home Rule Government Greenland; 2007.
4.
Larsen CVL, Dahl-Petersen IK, Kamper-Jørgensen F, Dalentoft L, Pars T. Midtvejsevaluering af folkesundhedsprogrammet Inuuneritta [Midterm-evaluation of the public health program Inuuneritta]. In. Copenhagen: National Institute for Public Health, SDU; 2011.
5.
Naalakkersuisut. In: Health Mo, editor. Inuuneritta II - Naalakkersuisuts strategier og målsætninger for folkesundheden 2013-2019. Nuuk: Home Rule Government Greenland; 2013. p. 20.
6.
Kickbusch I, Nutbeam D. Health promotion glossary. Geneva: World Health Organization; 1998.
7.
Norman CD. Health promotion as a systems science and practice. J Eval Clin Pract. 2009;15(5):868–72.CrossRefPubMed
8.
Mozaffarian D, Afshin A, Benowitz NL, Bittner V, Daniels SR, Franch HA, Jacobs DR, Jr., Kraus WE, Kris-Etherton PM, Krummel DA et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation 2012, 126(12):1514–63.
9.
Berkeley D, Springett J. From rhetoric to reality: barriers faced by health for all initiatives. Soc Sci Med. 2006;63(1):179–88.CrossRefPubMed
10.
Temple NJ. Strategic nutrition: a vision for the twenty-first century. Public Health Nutr. 2016;19(1):164–75.CrossRefPubMed
11.
Van Sluijs EM, Kriemler S. Reflections on physical activity intervention research in young people–dos, don’ts, and critical thoughts. Int J Behav Nutr Phys Activ. 2016;13(1):25.CrossRef
12.
Panter J, Guell C, Prins R, Ogilvie D. Physical activity and the environment: conceptual review and framework for intervention research. Int J Behav Nutr Phys Activ. 2017;14(1):156.CrossRef
13.
Pluye P, Potvin L, Denis J-L. Making public health programs last: conceptualizing sustainability. Eval Program Plann. 2004;27(2):121–33.CrossRef
14.
15.
Shediac-Rizkallah MC, Bone LR. Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Educ Res. 1998;13(1):87–108.CrossRefPubMed
16.
Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41(3–4):327.CrossRefPubMed
17.
World Health Organization: Health promotion: Ottawa charter. 1995.
18.
Weiss D, Lillefjell M, Magnus E. Facilitators for the development and implementation of health promoting policy and programs–a scoping review at the local community level. BMC Public Health. 2016;16(1):140.CrossRefPubMedPubMedCentral
19.
Haines A, Kuruvilla S, Borchert M. Bridging the implementation gap between knowledge and action for health. Bull World Health Organ. 2004;82:724–31.PubMedPubMedCentral
20.
Hendriks A-M, Jansen MW, Gubbels JS, De Vries NK, Paulussen T, Kremers SP. Proposing a conceptual framework for integrated local public health policy, applied to childhood obesity-the behavior change ball. Implement Sci. 2013;8(1):1.CrossRef
21.
22.
Bjerregaard P, Larsen CVL. Health aspects of colonization and the post-colonial period in Greenland 1721 to 2014. J North Stud. 2016;10(2):85–106.
23.
Vahl B, Kleemann N. Greenland in Figures 2014. Nuuk: Statistics Greenland; 2014.
24.
Ellsworth L, O'Keeffe A. Circumpolar Inuit health systems. Int J Circumpolar Health. 2013;72(1):21402.CrossRef
25.
Bjerregaard P, Niclasen B, Frederiksen N, Aidt EC. Hvordan går det? - Folkesundhed i Grønland 2014 [How is it going? - Public Health in Greenland 2014]. Nuuk: Ministry of Health, Greenland; 2015.
26.
De Savigny D, Adam T. Systems thinking for health systems strengthening. Geneva: World Health Organization: Alliance for Health Policy and Systems Research; 2009.
27.
28.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.CrossRefPubMedPubMedCentral
29.
Naaldenberg J, Vaandrager L, Koelen M, Wagemakers A-M, Saan H, de Hoog K. Elaborating on systems thinking in health promotion practice. Glob Health Promot. 2009;16(1):39–47.CrossRefPubMed
30.
Riley B, Willis C, Holmes B, Finegood D, Best A, McIsaac J. Systems Thinking and Dissemination and Implementation Research. In: Dissemination and implementation research in health: translating science to practice. edn. Edited by Brownson RC. New York: Oxford University Press; 2012:143–56.
31.
McKenzie A, Abdulwahab A, Sokpo E, W Mecaskey J. Building a Resilient Health System: Lessons From Northern Nigeria. In: IDS Working Paper. vol. 454. Brighton: Institute of Development Studies; 2015.
32.
Valaitis R, MacDonald M, Kothari A, O’Mara L, Regan S, Garcia J, Murray N, Manson H, Peroff-Johnston N, Bursey G. Moving towards a new vision: implementation of a public health policy intervention. BMC Public Health. 2016;16(1):412.CrossRefPubMedPubMedCentral
33.
Regeer BJ, Bunders JF. Knowledge co-creation: Interaction between science and society - A Transdisciplinary Approach to Complex Societal Issues. Den Haag: Advisory Council for Research on Spatial Planning, Nature and the Environment; 2009.
34.
Madni AM. Transdisciplinary system science: implications for healthcare and other problems of global significance. Transdisciplinary J Eng Sci. 2010;1(1):38–53.
35.
Pohl C, Hadorn GH. Methodological challenges of transdisciplinary research. Nat Sci Soc. 2008;16(2):111–21.CrossRef
36.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
37.
Grønlands Selvstyre [Home Rule of Greenland]. Finanslov for 2017 [Finance Act for 2017]. Nuuk: Grønlands Selvstyre [Home Rule of Greenland]; 2016.
38.
O’Flynn J. From headline to hard grind: the importance of understanding public administration in achieving health outcomes - comment on "understanding the role of public administration in implementing action on the social determinants of health and health inequities". Int J Health Policy Manage. 2016;5(7):439.CrossRef
39.
Santhidran S, Chandran V, Borromeo J. Enabling organizational change–leadership, commitment to change and the mediating role of change readiness. J Bus Econ Manag. 2013;14(2):348–63.CrossRef
40.
Christensen T, Lægreid P. The whole-of-government approach to public sector reform. Public Adm Rev. 2007;67(6):1059–66.CrossRef
41.
MacLean LM, Clinton K, Edwards N, Garrard M, Ashley L, Hansen-Ketchum P, Walsh A. Unpacking vertical and horizontal integration: childhood overweight/obesity programs and planning, a Canadian perspective. Implement Sci. 2010;5(1):36.CrossRefPubMedPubMedCentral
42.
Jackson SF, Perkins F, Khandor E, Cordwell L, Hamann S, Buasai S. Integrated health promotion strategies: a contribution to tackling current and future health challenges. Health Promot Int. 2006;21(suppl_1):75–83.CrossRefPubMed
43.
Greer SL, Lillvis DF. Beyond leadership: political strategies for coordination in health policies. Health Policy. 2014;116(1):12–7.CrossRefPubMed
44.
Clavier C. Implementing health in all policies – time and ideas matter too!: comment on" understanding the role of public Administration in Implementing Action on the social determinants of health and health inequities". Int J Health Policy Manage. 2016;5(10):609.CrossRef
45.
Leppo K, Ollila E, Pena S, Wismar M, Cook S. Health in all policies - seizing opportunities, implementing policies. Malta: Ministry of Social Affairs and Health, Finland; 2013.
46.
Guglielmin M, Muntaner C, O’Campo P, Shankardass K. A scoping review of the implementation of health in all policies at the local level. Health Policy. 2017;122(3):284–92.CrossRefPubMed
47.
Holt DH. Intersectoral policymaking for health?: from policy to practice: a qualitative study of challenging implementation. Copenhagen: Syddansk Universitet; 2017.
48.
Broerse J, Essink D, Bunders J. Reflections on persistent problems and strategies for health system innovation. In: Broerse J, Bunders J, editors. Transitions in Health Systems: Dealing with persistent problems. Amsterdam: VU University Press; 2010. p. 209–29.
49.
Bowen GA. Document analysis as a qualitative research method. Qual Res J. 2009;9(2):27–40.CrossRef
50.
Curry LA, Nembhard IM, Bradley EH. Qualitative and mixed methods provide unique contributions to outcomes research. Circulation. 2009;119(10):1442–52.CrossRefPubMed
51.
Gray DE. Doing research in the real world, Third edn. London: SAGE; 2014.
52.
Metadata
Title
Determinants of an integrated public health approach: the implementation process of Greenland’s second public health program
Authors
Christine Ingemann
Barbara J. Regeer
Christina V. L. Larsen
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-6253-4

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