Applying Theory to Practice

Integrating Health Equity into Community Health Nursing Practice

Purpose

• Situating social justice and equity in community health nursing practice

• Concept mapping on strategies to integrate equity into practice

• Small group discussion to share successes and challenges in integrating equity into CHN practice

CHNC Standards of Practice

• Although social justice was implicitly integrated into the values base of the standards, there was a need to integrate social justice and equity more explicitly into each standard

• Thus, the CHNC standards were recently revised based on an analysis using the CNA Social Justice Gauge and an extensive Canada wide consultation with CHNs

Revised CHNC Model

• Values – social justice is named explicitly as a value rather than being incorporated into caring

• Theoretical Foundations have been elaborated, based on CHN Meta-paradigm concepts, and drawing on theories and models directly relevant to CHN – e.g., critical caring theory, the population health promotion model.

Revised CHN Model

• Community health nursing standards have been expanded to 7 from 5

• Each standard explicitly incorporates social justice into one or more of the specific statements

• Statements also explicitly name equity and the determinants of health as important foci of competent practice

Implications

• Thus, a focus on equity and social justice is not only a moral imperative for CHNs, but is an explicit expectation of our practice

• Yet, our research on integrating equity into practice has found that CHNs struggle with what it means to apply an equity lens and are asking for guidance in how to do it

Applying an Equity Lens to Public Health Practice: Concept Mapping to

Identify Strategies and Challenges

Renewal of Public Health Systems Research Team

CIHR Emerging Team Grant

Research Context

• This study was a component of a five year program of research examining the implementation and impact of public health renewal processes in two Canadian provinces (British Columbia and Ontario)

• Five integrated projects/foci make up the REPHS project, one of which is an examination of how an equity lens is being integrated into core public health programs in BC and ON

Purpose of the Study

• to understand what Public Health decision makers and practitioners believe will enable them to integrate health equity into practice and decision making using concept mapping

Concept Mapping

• Concept mapping is a structured conceptualization process used to develop a framework of participants’ understanding of a particular concept and the processes related to the concept

• Done in 3 phases:

– brainstorming

– sorting and rating

– interpretation

Phase 1: Brainstorming

• Prompt: Equity can be incorporated into public health practice and/or decision–making by…

• Total participants = 60 including front line staff, managers, and decision makers in BC & ON

• Brainstorming statements were synthesized resulting in 33 statements

Phase 2: Sorting and Rating

• Statements are then sorted into groups for cluster analysis and rated according to importance and feasibility

Equity Concept Map

Cluster 1: Balancing tensions

To promote equity, we need to:

• balance PH programs that promote population health (universal programs) and targeted programs for vulnerable or marginalized populations

• balance access points to PH services for all and access that is fair or targeted

• Balance individual personal choices and development of intersectoral policies that create supportive structures to allow people to make healthy choices

• clearly define measures to monitor whether the right balance is being achieved

Cluster 2: Common, simple messaging

• to incorporate equity into public health practice and/or decision-making it is necessary to have a clear common message that is:

– understandable,

– agreed upon

– and one that people buy into.

Cluster 3: Driving healthy public policy

• To promote health equity, there is need for healthy public policy aimed at reducing health inequities. This can be achieved by:

– advocating for policy change at all levels

– working with policy makers to integrate equity in all policies through consideration of political, social and economic factors and

– Allocating financial resources

Cluster 4: Building capacity in the workforce and workplace

• To incorporate equity into practice and/or decision-making, there is a need to build capacity of the workforce and provide a supportive working environment.

• Building workforce capacity involves: – identifying equity competencies required of staff

– educating and training staff

– having a diverse workforce that represents the community.

• A supportive work environment enables innovative thinking and action on equity and staff involvement in planning and development of strategies.

Cluster 5: Creating a culture of equity

• To promote health equity in practice and decision-making, it is necessary to establish a culture of equity.

• A culture of equity requires leadership at all levels to support the integration of an equity lens in all public health planning, service delivery and evaluation.

Cluster 6: Building a knowledge platform

• Promoting health equity in practice and/or decision-making requires:

– a common understanding of equity

– the exchange of equity-related knowledge within the health sector and with community partners

– Providing examples of how to do health equity work

Cluster 7: Honouring Multiple Ways of Knowing

• Promoting health equity in practice and/or decision-making requires generating, using and valuing multiple forms of evidence

• This includes community knowledge and data about populations at risk of inequities

Importance and Feasibility: BC and Ontario

1. Balancing Tensions

2. Common Simple

Messaging

3. Driving Healthy

Public Policy

4. Building Capacity

5. Creating a Culture of

Equity

6. Building a Knowledge

Platform

7. Honouring Multiple

Ways of Knowing

CONCLUSIONS

• Strong evidence that developing healthy public policy is important strategy for reducing health inequities, and PH practitioners agree that it is important

• Yet, they are sceptical that this can happen and do not perceive it as feasible

• If practitioners do not see this work as feasible, they may not be inclined to seek out opportunities to work with policy makers on this issue, or to advocate for policies to address health equity

CONCLUSIONS

• At the same time, this study, grounded in the experiences of both practitioners and decision makers, provides some concrete direction about potential actions that are identified as both feasible and important.

• The most feasible in the short term are building a knowledge platform and building capacity in the workforce and workplace

DOES THIS RESONATE FOR YOU?

Group Discussion

GIVEN WHAT YOU HAVE JUST HEARD: • Reflect – on your own experiences with

integrating equity into your practice

• Pair and Share – your successes and challenges in doing this with one person

• Discuss – what you have heard with the others at your table

• Write down the most inspiring success and the two most important challenges

Health Equity Tools

• Equity Lens in Public Health Research Program

Development of an inventory of equity tools

http://www.,uvic.ca/research/projects/elph

• NCCDH and NCCHPP Equity Tools

http://nccdh.ca/resources/entr/tools-and-approaches