impact evaluation of three health equity impact assessments

Impact Evaluation of Three Health Equity Impact Assessments

B Harris-Roxas, P Bazeley, L KempCentre for Health Equity Training, Research and Evaluation (CHETRE)

Part of the UNSW Research Centre for Primary Health Care and EquitySydney, Australia

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But little is known about its effectiveness and the circumstances under which it is effective

Impact of three health equity impact assessments (HEIAs) onsubsequent decision-making and implementation

Rapid

Health sector proposals

Impact evaluation 18-24 months following completion

Narrative interviews

Document analysis

Analysis: Approach outlined by Colaizzi*

* Colaizzi PF. Psychological Research as the Phenomenologist Views It. In: Valle RS, King M, editors. Existential Phenomenological Alternatives for Psychology. New York: Oxford University Press, 1978:48-71.

Evidence of changes to decision-making and implementation, but these were hard to attribute solely to the HEIAs

Parameters

Decision-making processes

Decision-makers

Type of HIA

Broader Context

Inputs

Proposal

Capacity and experience

Resources

Time

Organisational arrangements

Process

Procedural fidelity

Involvement of decision-makers and stakeholders

Transparency

Trade-offs

Review

Proximal Impacts

Informing decisions

Changing decisions and

implementation

Changes in health determinants

Predictive efficacy

Achieving goals

Distal Impacts

Understanding

Participatory learning

Influencing other activities

Engagement

Perception of HIA

Values, Purpose and Goals

Parameters

Decision-making processes

Decision-makers

Type of HIA

Broader Context

Inputs

Proposal

Capacity and experience

Resources

Time

Organisational arrangements

Process

Procedural fidelity

Involvement of decision-makers and stakeholders

Transparency

Trade-offs

Review

Proximal Impacts

Informing decisions

Changing decisions and

implementation

Changes in health determinants

Predictive efficacy

Achieving goals

Distal Impacts

Understanding

Participatory learning

Influencing other activities

Engagement

Perception of HIA

Values, Purpose and Goals

All three HEIAs identified potential health inequity impacts that had not been previously identified in planning

But it was hard for people to recognise that their understanding of potential health equity impacts had changed

"I’m not convinced that [the HEIA] made people do things differently, because I think that they probably, should’ve, would’ve, hopefully would’ve, done those things anyway."

The things we don’t know we didn’t know?

Lack of consensus about the purpose of doing of doing the HEIAs

"We didn’t have a shared understanding of why we were undertaking it. Our purposes were probably different from [the other stakeholders’] purposes, and maybe that’s where they don’t work, but if you have two differing purposes, unless you can fully appreciate what those two different purposes are, maybe it doesn’t work out as well as it could."

More explicit conflict, discussion of values and desired outcomes

More information http://bit.ly/g0CDI

b.harris-roxas@unsw.edu.au