Dissemination of Heart Health Promotion in Ontario's Public Health System: A Social Ecological Perspective

Abstract

The research reported in this dissertation examines the dissemination of heart health promotion within the Ontario public health system. It contributes to a relatively new research agenda to understand how to enhance implementation of the new public health; to apply knowledge of effective community- and population-based prevention. Three studies are reported, which extend research conducted in Ontario from 1994 to 1998 as part of the Canadian Heart Health Initiative Ontario Project (CHHIOP). Study one combined diffusion and social ecological theories to examine the dissemination process at the level of the public health system and over a ten year period. Studies two and three examined the implementation stage in more depth, with a view to understand variability across Ontario communities. Study two was a quantitative path analysis to identify determinants of 1997 levels of implementation, and study three was a comparative case study to understand change in implementation from 1994 to 1996. Main data sources were quantitative and qualitative data from CHHIOP. Findings reinforce the need for a systems view of dissemination; that dissemination is a long-term, iterative process; and that organizational capacity building is a vital part of the dissemination process, especially when new practices represent a significant departure from traditional concepts and ways of doing business. The research demonstrates that the interplay of internal organizational factors (e.g. champions, leadership, organizational structure) and external system factors (e.g. research, political priorities, experiences of other jurisdictions, partnerships) helps to explain movement within and across dissemination stages. Findings suggest promising areas for dissemination research, including replicating similar research in other public health systems. Findings also suggest promising strategies to accelerate the dissemination of effective health promotion, including specific strategies to further enhance heart health promotion in Ontario.