Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities- A Mixed Methods Study Protocol

Monica O'Mullane; Tara Kenny; Kirsty Nash; Sheena M. McHugh; Paul Kavanagh; Katherine Smith

doi:10.12688/hrbopenres.13873.1

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Study Protocol

Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities- A Mixed Methods Study Protocol

[version 1; peer review: 2 approved with reservations]

Monica O'Mullane ¹, Tara Kenny¹, Kirsty Nash¹, Sheena M. McHugh¹, Paul Kavanagh², Katherine Smith³

Monica O'Mullane ¹, Tara Kenny¹, [...] Kirsty Nash¹, Sheena M. McHugh¹, Paul Kavanagh², Katherine Smith³

PUBLISHED 20 Mar 2024

Author details Author details

¹ School of Public Health, University College Cork, Cork, County Cork, Ireland
² Health Services Executive, Tullamore, County Offaly, Ireland
³ School of Social Work and Social Policy, University of Strathclyde, Glasgow, Scotland, UK

Monica O'Mullane
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Tara Kenny
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Visualization

Kirsty Nash
Roles: Formal Analysis, Methodology, Project Administration

Sheena M. McHugh
Roles: Conceptualization, Formal Analysis, Methodology

Paul Kavanagh
Roles: Conceptualization, Writing – Review & Editing

Katherine Smith
Roles: Conceptualization

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Public health research presents compelling evidence that health is socially determined. To address structural inequalities and inequities in health, public policies require intersectoral development and implementation. Health Impact Assessment (HIA) is an established approach for analysing potentially detrimental health impacts of policies, programmes, and projects, as well as potentially positive impacts and opportunities. National public health policy, Healthy Ireland (2013–2025), endorses an intersectoral whole-of-system approach to ensure that health is a central part of all relevant policy areas. HIA is endorsed in this policy as one way to drive this agenda. Synergising with this policy commitment for HIA, the all-island Institute of Public Health Ireland produced revised HIA guidance in 2021. Two HIAs will be carried out as part of this project, including one at a local policy level, addressing the Cork City Development Plan (2022–2028), and the second HIA at a national policy level, addressing the Irish Government’s Climate Action Plan (2024). The updated HIA guidance will be used in the conduct of these HIAs. This research project involves a co-creation of a Health Impact Assessment Implementation Model by employing an action research approach with implementation science frameworks to the conduct of the two HIAs. Therefore, the process of doing the HIAs will form the basis for the research study. In order to enhance meaningful community involvement in HIA in Ireland, the project will co-create a Community Engagement Toolkit for HIA. This Model will strengthen researcher, policy actor, practitioner, community, and voluntary sector capacity to collaboratively develop and implement intersectoral and equitable policy responses to major population health issues.

Keywords

Health Impact Assessment, action research, implementation science, city planning, climate action

Corresponding author: Monica O'Mullane

Competing interests: No competing interests were disclosed.

Grant information: This work was supported by the Health Research Board [EIA-2022-001].

Copyright: © 2024 O'Mullane M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: O'Mullane M, Kenny T, Nash K et al. Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities- A Mixed Methods Study Protocol [version 1; peer review: 2 approved with reservations]. HRB Open Res 2024, 7:14 (https://doi.org/10.12688/hrbopenres.13873.1) First published: 20 Mar 2024, 7:14 (https://doi.org/10.12688/hrbopenres.13873.1) Latest published: 06 Feb 2025, 7:14 (https://doi.org/10.12688/hrbopenres.13873.3)

Introduction

Public health research has shown that our health and wellbeing are affected by the circumstances into which we are born, grow, live, work and age. These wider social, economic, political and environmental circumstances are a greater determinant of health status than individual factors and behaviours (CSDH, 2008). Health inequalities, which are a result of systemic inequities across these wider determinants of health on population groups, require intersectoral action from beyond health sector contexts (Marmot, 2017; Solar et al., 2023). In an Irish context, published by the government Department (Ministry) of Health, the Healthy Ireland national survey (2019) reaffirmed that people living in deprived areas are more likely to suffer from health conditions compared to those in wealthier areas (DOH, 2019). Employment status and education is associated with people reporting ‘good or very good health’ in the Healthy Ireland survey (DOH, 2023; Duffy et al., 2022). The impact of the COVID-19 pandemic in Ireland was experienced more negatively by marginalised communities in society (EAPN, 2020). Clearly, what is needed is a tangible way for all policy sectors to work collaboratively in improving population health and tackling health inequalities.

HIA is a process that encompasses a set of tools to identify best possible outcomes related to categories of objectives needed to strengthen the promotion of health and health equity. HIA is “a process which systematically judges the potential, and sometimes unintended, effects of a project, programme, plan, policy, or strategy on the health of a population and the distribution of those effects within the population” (Winkler et al., 2021: 3). The WHO Gothenberg Consensus paper (1999) identified four core values of HIA, which continue to underpin the process to this day, namely, democracy, equity, ethical use of evidence and sustainable development. HIA is conceptually underpinned by the wider determinants of health (Solar & Irwin, 2010). It is through the examination of this aforementioned ‘distribution of effects’ across identified population groups, and collection of data within HIA, that health equity can be improved, and health inequalities tackled. HIA is an established approach for implementing Health in All Policies (DoH, 2013; Green et al., 2021b; Pyper et al., 2021) in order to tackle health inequalities (Douglas & Scott-Samuel, 2001). HIA, as well as providing formal evidence of potential health-related outcomes across sectors, has been shown to broaden the set of issues under scrutiny, the types of decisions assessed, and the range of actors involved (Green et al., 2021a). Lynch et al. (2023) advocate for governmental support of HIA as a way to implement Health in All Policies and improve health equity across policy domains.

Despite continued HIA practice and policy for more than two decades, (O'Mullane, 2013; Rogerson et al., 2020), HIA implementation remains ad hoc in many jurisdictions. Ireland’s experience is no different, with HIA practice and policy stopping and starting since its first endorsement in the public health policy Quality and Fairness: A Health System for you, published by the then Department (government Ministry) of Health and Children (DOH&C) (2001). HIA has been criticised over the years, predominantly for adding to the work burden of statutory stakeholders (Linzalone et al., 2018), becoming a tick-the-box exercise, and not aligning the informational pathway from the HIA with the relevant respective policies, projects or programmes. In Ireland, research found it often did not have impact beyond the health sector because of poor intersectoral collaborations (O'Mullane, 2015). This finding concurs with a review of HIA progress in Ireland, which concluded that an implementation gap exists in relation to surmounting cultural and professional boundaries and acceptance of a joint intersectoral approach (Gillespie & McIldoon, 2009). Other challenges for implementing HIA identified in the review include time, capacity, and resource limitations; issues regarding roles and responsibilities; and the impression of policy stakeholders is that HIA is a complicated process. These challenges are deemed surmountable (Gillespie & McIldoon, 2009) by way of adopting a triadic approach to enhancing HIA implementation in Ireland by a) improving the HIA implementation process; b) providing HIA capacity-building; c) garnering political will and leadership. HIA-IM will develop a HIA implementation model addressing points a and c; it will also indirectly inform the Institute of Public Health HIA programme of capacity-building (b) (IPH, 2020). This multifocal approach to enhancing Health in All Policies through HIA implementation has been demonstrated in other countries, including Wales (Green et al., 2020), Scotland (Douglas et al., 2020), Australia (Delany et al., 2014), and France (Jabot et al., 2020). What can be observed also over the past two decades is the enactment of innovative and creative ways of implementing HIA, in local and/ or national policy development, adopted across in many countries across the globe (O'Mullane, 2013).

Current public health policies on the island of Ireland produced by the respective Departments (Ministries) of Health, namely Healthy Ireland (2013–2025) (DoH, 2013) and Making Life Better (2013–2023) (DHSSPS, 2013) endorse HIA as a way to facilitate this intersectoral, Health in All Policies, whole-of-government way of working for population health. In line with this endorsement, the all-island Institute of Public Health Ireland, published new HIA guidance in 2021 (Pyper et al., 2021), as part of a reinvigorated policy support for HIA across the island. Also, efforts in recent years in Ireland have sought to counter siloed ways of working for health and wellbeing. The Healthy Ireland Strategic Action Plan 2021–2025 (DOH, 2021) was launched in 2021, including the Sláintecare Healthy Communities Programme which puts in place a legal structure for local authorities to work in an intersectoral way with community agencies and health services for health and wellbeing improvement. This action plan aims to address health inequality in Ireland through an intersectoral Health in All Policies approach. Healthy Ireland recognises the relevance and importance of HIA in operationalising this intersectoral response. However, the Healthy Ireland action plan does not address the challenges of HIA implementation (Gillespie & McIldoon, 2009; Kearns & Pursell, 2011) including the issue of how the approach could tangibly facilitate intersectoral action in tackling health inequalities. HIA-IM seeks to address these challenges through the co-creation of the HIA implementation model.

‘Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities’ (acronym: HIA-IM) is funded by the Health Research Board (HRB) under the Emerging Investigator Award (EIA), 2023 to 2026. Dr Monica O’Mullane holds this award as Principal Investigator, with team members involved in the project from across University College Cork (UCC), the Institute of Public Health Ireland, Cork Environmental Forum (CEF), the Environmental Protection Agency (EPA), Cork City Council, the Health Services Executive (HSE), Public Health Wales, Ben Cave Associates Insight, University of Galway, University of Bradford, University of New South Wales, Trinity College Dublin and University of Strathclyde. The HIA-IM Public Involvement Consultation Group includes members from Cork Environmental Forum, Cork Healthy Cities, Global Action Plan, Coalition 2030, Coast Watch Ireland, Global Health Ireland, Independent Living Group and Social Justice Ireland. The project is co-hosted in University College Cork between the School of Public Health and the Institute for Social Science in the 21^st Century (ISS21).

The goal of the project is to critically explore the process of developing a Health Impact Assessment implementation model that will enhance researcher, policy actor, practitioner, community, and voluntary sector capacity to collaboratively develop and implement intersectoral and equitable policy responses to major population health issues. The project involves doing two HIAs as part of the research study, one at a local policy level, addressing the Cork City Development Plan (2022–2028), and the second HIA at a national policy level, addressing the Irish Government’s Climate Action Plan (2024). Simultaneously, the process of doing the HIAs will form the basis for the research study using an action research approach integrating implementation science theoretical frameworks. Research participants included in the study are the members of each of the two HIA Steering and Working Groups (Group A), as well as individuals within key organisations involved in the HIAs with capacity to use and embed the practice HIA within existing structures (Group B). The aim is that by drawing learning from participants’ lived experience and reflections across Groups A and B, we can connect evidence, policy, and practice in a co-created manner to directly inform the iterative building of the contextualised HIA implementation model. This model will be developed in a way to practically inform the conduct of HIA in practice through the roll out of the HIA implementation programme, led by the Institute of Public Ireland, as well as enhancing capacities and confidence of individuals in doing HIAs going forward. A key component of the HIA implementation model will be the creation of a Community Engagement Toolkit to facilitate meaningful community engagement, specific to the conduct of HIAs. Although the focus of the project is on HIA as one approach for implementing intersectoral action for improved population health, the exploratory nature of the work will reveal insight and nuances in the perceptions of the approach, in using the IPH guidance, and problematising HIA as a suitable approach for creating Health in All Policies within an Irish context.

Study aims and objectives

Using revised Irish HIA guidance (Pyper et al., 2021), this mixed methods research study will employ action research approach integrated with implementation science theory to iteratively develop a contextualised HIA Implementation model. HIA-IM will address five research objectives across four work packages which align with national public health policy priorities for population health in Ireland (DHSSPS, 2013; DoH, 2013), with Northern Ireland (DHSSPS, 2013), and internationally (WHO, 2013). Through these objectives, HIA-IM will address the HIA implementation gap, as outlined in research on HIA implementation (Gillespie & McIldoon, 2009) and national policy (DOH, 2021; DoH, 2013).

The five research objectives align with four work streams, as outlined in the methods section:

1. Action research-led design and implementation of two HIAs using revised national HIA guidance. HIA 1 on the Cork City Development Plan (2022–2028) and HIA 2 and on the Irish Government Climate Action Plan 2024

The conduct of the two HIAs lays the foundation of all research activities in the project, enables the collection of lived experience and reflections of those engaged in the HIAs, and involves the public in order to both inform the HIAs and co-produce the research activities in the building of the HIA implementation model. Both HIAs require policy involvement from the key proponents in order to inform the respective policies, and so there is potential the HIA focus could change depending on this involvement. The first work stream involves the sequential conduct of the two HIAs alongside the application of the action research cycle. The work stream includes two tasks.

i. Conduct two HIAs on the Cork City Development Plan 2022–2028 (HIA 1) and the Government Climate Action Plan 2024 (HIA 2).
ii. Apply an action research cycle during the conduct of the two HIAs.

2. Identification of factors that influence the process of HIA implementation using multiple implementation science frameworks.
3. Development of a Community Engagement Toolkit in order to optimise inclusive community participation in HIA in Ireland
4. Iterative development of a contextualised, contemporary, Irish HIA implementation model by integrating and triangulating qualitative and quantitative data from all work streams

Study design

This research study will use multiple implementation science frameworks (Damschroder et al., 2022; Finch et al., 2018) within an action research approach (Bradbury, 2022) to co-produce in an iterative way a contextualised Health Impact Assessment implementation model with key partners. HIA implementation is optimised when relevant stakeholders contribute evidence and insight (den Broeder et al., 2017). HIA implementation with meaningful community engagement is integral to its sustainability as a public health response for tackling health inequalities, as has been evidenced in previous research (Green et al., 2021a). Using a community-centered and co-design approach, the first Community Engagement Toolkit for HIA in Ireland will be co-created with key partners. This Toolkit will be a practical resource to be used in carrying out participatory HIAs in Ireland, complementing the use of HIA guidance. In using the HIA approach, the research study is founded on improving health equity for population groups who will be affected by the implementation of the policy under study, which in the case of HIA-IM, includes local urban policy and national climate action policy. The equity lens allows us to consider the health impacts of policies under study. The rationale, approach and timing of this research study is designed to inform the roll-out of the HIA implementation programme led by the Institute of Public Health, synergising with key national population health priorities and policy implementation going forward. Quantitative and qualitative methods will be employed underpinned by co-design and co-production approaches. A scoping review of factors influencing HIA implementation in order to create research evidence that informs contextualised responses to create intersectoral policy for population health.

Action research has been shown to improve the contextualised nature of implementation procedures within organisational structures, compared to other research methods (Bush et al., 2017). However, little research has been conducted on the use of action research methods in implementation research, specifically in assessing implementation processes and outcomes of policies and policy-informing processes, such as HIA. Action research is applied in order to improve specific practices through critical reflection (ibid). It is founded on participation and collaboration of individuals who work through an action research cycle which includes planning, acting, outcome, and reflection, to provide feedback (collected data) in order to introduce improvements to a specific practice. It presents a learning opportunity for data collection of participants’ reflections and learnings (McNiff, 2013). Action research is an approach that co-creates research with people, places praxis and reflection as primacy, and is underpinned by social constructivism (Bradbury, 2022). Hence, within this project, the research team adopts a critical sociological lens to allow space for reflections of social and power relationships with any nuanced implementation dynamics arising throughout the research, specifically in the conduct of the HIAs (Ahmed, 2012; Nettleton & Bunton, 1995). The research team, who will participate in the two HIA Working Groups, will consciously embody a reflexive research role within the study in order to capture key reflections with participant observations, aligned in the spirit of meaningful action research (Archibong et al., 2016). Planned time and space for research analysis during data collection will take the form of two research analysis retreats for each HIA. This data will be triangulated with other research data produced within the study to create a holistic picture of HIA in Ireland, informing the resulting implementation model.

Methods

Work stream 1: Action research-led design and implementation of two HIAs using revised national HIA guidance. HIA 1 on the Cork City Development Plan (2022–2028) and HIA 2 and on the Irish Government Climate Action Plan (2024)

1.1. Design and conduct a HIA on the Cork City Development Plan, 2022–2028 (HIA 1) and subsequently on the Government Climate Action Plan 2024 (HIA 2), using recently revised national HIA guidance

The HIA Steering Group and Working Groups, which will be established before each HIA commences, will steer the direction and scope of each HIA (Steering Group) and carry out the work (Working Group). Minutes from the Steering Group and Working Group meetings, which will record matters arising and decisions made at each stage of the seven HIA stages, will be used as research data.

In summary, the following processes will be implemented using HIA stagiest methodology as outlined in the IPH HIA guidance (Pyper et al., 2021) (orange stream in Figure 1):

Figure 1. Proposed research framework, drawing on the action research cycle employed by Archibong et al. (2017).

1. Screening: The screening tool will be applied to the national and local policies, to establish the range and distribution of potential impacts (p. 110).
2. Scoping: The governance for the whole assessment process is established at this stage for each HIA. The scoping stage also decides on (based on screening tool output) the determinants of health and the populations to be assessed, as well as the methods by which they will be assessed (p. 40)
3. Analysis: This is the most labour-intensive stage of the process. It involves the gathering, generating (when not available) and synthesis of quantitative and qualitative evidence of potential health impacts, the assessment of the distribution of those impacts (including potential impacts on health inequalities) and the work of drawing appropriate and relevant conclusions. The analysis involves an assessment according to guide questions (p. 47) as to the ‘likely’ and significant’ potential impacts, based on evidence. The analysis will draw on relevant sociodemographic data from the Central Statistics Office, including indices of deprivation mapped at small area (District Electoral Division) level - Pobal Maps and on population health data from the Healthy Ireland Outcomes Framework.
4. Reporting: The HIA will report * a change to the policy and/or * a conclusion on particular effects, for example, that an effect is likely and significant.
5. Implementation: At this stage, direct pathways will be identified by the steering groups for the HIA findings to be used in the two respective policies- City Development Plan and Government Annual Climate Action Plan
6. Monitoring: Monitoring will track the actual effects and can be conducted during different phases of the policy. Part 6 of the Technical Guidance (Pyper et al., 2021) provides a tool for developing monitoring measures.
7. Evaluation: A process and impact evaluation will be conducted at this stage of the HIA

1.2. Apply an action research cycle concurrent to carrying out HIA 1 and HIA 2 (Research objective 2)

As illustrated in Figure 1 (blue stream) a five-stage action research cycle comprising Investigate, Plan, Act, Outcome and Reflect will be applied to the seven HIA stages (Figure 1- orange stream) of HIA 1 and HIA 2. Such continual application of an action research cycle while Task 1.1 is delivered will ensure data from HIA processes are captured. This is a novel approach to researching HIA in practice, and will capture data, which is specific to the Irish process of HIA, thus informing the HIA implementation model.

Data on the implementation of both HIAs will be collected at each of the five action research cycle stages:

1. Investigate: Prior HIA stage 1 (Screening), participants’ reflections on the planned HIA process will be captured using a World Café forum. World Café is a participatory action research method widely used in organisational change processes, when engaging community and health care stakeholders. It is a conversational process, also termed a self-facilitating focus group, that helps groups to engage in constructive dialogue around critical questions, to build personal relationships, and to foster mutual learning (Löhr et al., 2020). It involves three rounds of conversation groups, recording results in the form of text, sketches, or symbols on paper. Through providing a forum of open informal dialogue and mutual learning, the World Café method tends to motivate participants. In addition to the World Café, data will be collected in the form of the research team’s observation notes.
2. Plan. HIA steering group participants’ perceptions and reflections on conducting the Screening and Scoping of HIA 1 and HIA 2 will be captured using a Stop & Share method (Archibong et al., 2016), an individual-level rapid interview method (20–30 minutes) A set of pre-defined prompts eliciting reflection on conducting the stages will offer an opportunity for participants to reflect individually.
3. Act: HIA steering group participants’ perceptions and reflections on the Analysis stage of HIA 1 and HIA 2 will be captured by the research team in the form of observation notes and using the Stop & Share method.
4. Outcome aligns with the stages 4 (Implementation) and 5 (Reporting) of the HIA process. Participant reflections will be collected using the Stop & Share method between stages 4 and 5. Therefore, this will capture participants’ experiences while writing the HIA report.
5. Reflect. A World Café will be conducted in order to capture participants’ collaborative reflections. It will be conducted in the same way as described for the first World Café. This further World Café will capture participants reflections in between the Monitoring and Evaluation stages of HIA 1 and HIA 2 (stages 6 and 7 of the HIA process).

A co-production workshop for data analysis is planned with key stakeholders including the project’s public involvement consultation group and the Institute of Public Health Ireland will take place. In line with action research ethos, this workshop will ensure key stakeholders will engage in the co-design of data analysis, ensuring that the people envisaged to work with HIA and use the resources of HIA-IM after project completion, will be involved in the research process. Incorporating the outcomes from this co-production of analysis, data will be further refined using the reflexive thematic analytical framework (Braun & Clarke, 2022). Reliability checks will be used in the application of this project’s qualitative research methods (Heikkinen et al., 2012), including the inter-coder reliability measures to ensure the highest possible levels of consistency, validity and transparency in the data analyses.

Work stream 2: Identification of factors that influence the process of HIA implementation, drawing from the Normalisation Process Theory (NPT) and the Consolidated Framework for Implementation Research (CFIR) (research objective 3) (Figure 1, green stream)

HIA-IM will employ a hybrid implementation science framework, drawing from the Normalisation Process Theory (NPT) (Finch et al., 2018) and the Consolidated Framework for Implementation Research (CFIR) (Damschroder et al., 2022). Relevant theoretical constructs from both frameworks will be used in order to analyse the process of HIA (NPT) and determinants on HIA implementation (CFIR). NPT comprises of four constructs; Coherence- what is the work?, Cognitive Participation- who does the work?, Collective Action- how does the work get done?, Reflexive Monitoring- how is the work understood? NPT in particular seeks to examine the implementation processes of complex interventions such as HIA, understood as deliberately institutionally sanctioned interventions that are formally defined; planned; and intended to lead to a changed outcome (Finch et al., 2018). NPT works to assess the implementation processes of those directly engaged in the intervention (HIA) as well as individuals not directly engaged but knowledgeable of the process (ibid). CFIR comprises of five domains; intervention/ innovation characteristics, inner and outer setting, the individuals involved, process of implementation. The two setting domains of CFIR will be particularly illustrative in generating data on the wider institutional and policy contexts within which participants are working.

HIA 1 and HIA 2 steering group members from Task 1.1 will form Group A for work stream 2. Each HIA Steering and Working Group structure will include 12 participants. Group B will comprise of individuals within key organisations involved in the HIAs with capacity to use and embed the practice HIA within existing structures (Group B). A snowballing technique will be used to identify and recruit Group B participants, estimated at 20 individuals per HIA (40 in total).

An explanatory mixed-methods approach in data collection and analysis will be employed to capture implementation processes. Quantitative data will inform qualitative data collection and analysis, integrated sequentially with qualitative data (Figure 1- green stream). The standardised validated NoMAD (Finch et al., 2018) questionnaire, with additional questions from CFIR domains, will be administered to Groups A and B. The NoMAD questionnaire assesses implementation processes from the perspective of professionals involved in the work of implementing complex interventions such as HIA.

Once the first HIA stage of screening is completed, both groups A and B will be asked to complete the questionnaire online. They will be asked again after the HIA analysis stage, and following completion of the HIA with the publication of the HIA report. In total the groups will complete the questionnaire three times during the process of the HIA.

Following the Analysis HIA stage, respondents from groups A and B will be invited to participate in semi-structured interviews. A purposive sample will be chosen, using selection criteria (organizational affiliation, decision-making authority, gender and intersectionalities balance), from those who volunteer for interviews. It is expected that all interviews will take place face-to-face in the participant’s workplace setting. The interview schedules will incorporate the NPT and CFIR constructs as well as findings from the first two rounds of questionnaire administration.

At the end of each HIA, further semi-structured interviews will be held individually with research participants. The interview guide will be framed by the five domains of CFIR. This will allow the research team to elicit perceptions and experience on factors affecting the implementation of HIA from the perspective of individuals in the HIA Steering and Working Groups.

Work stream 3- Co-produce a Community Engagement Toolkit in order to optimise community participation in HIA in Ireland (research objective 4)

The aim of this work stream is to capture learning from the HIA Analysis stage (stage 3 of HIA process (Figure 1) using a set of community engagement indicators, building on Frewer et al. (2000) criteria for effective public participation. The HIA Analysis stage includes community consultation, to inform the HIA with community knowledge. The goal is to counter potential community disenfranchisement from transformative policy change from going “over their heads,” as has been highlighted by Haigh et al. (2020: 1).

One of the four values central to HIA is democracy (WHO, 1999). HIA enables a generation and synthesis of quantitative and qualitative evidence, including community knowledge. The Healthy Ireland Framework 2013–2025 with its Strategic Action Plan 2021–2025 both highlight the importance of Empowering People and Communities (DOH, 2021; DOH, 2023) through intersectoral responses including HIA. However, HIA processes often lack meaningful community engagement (den Broeder et al., 2017). As Haigh et al. (2020) conclude from their study of community engagement in HIA, this is identified as a missed opportunity to achieve benefits of community engagement during the assessment of planning processes that occur as part of HIAs. The Institute of Public health HIA guidance does not detail how community engagement could occur. HIA practitioners, scholars and advocates such as Green et al. (2021c) have demonstrated the importance of the community voice in developing sustainable HIA implementation.

A conceptual framework for community engagement will be built from the relevant theoretical and grey literature review, drawing on criteria for effective public participation for HIA (Frewer et al., 2000).

The review will draw on literature underpinning the rationale for community participation in HIA, identifying tools and practices that have been used to effectively facilitate communities in engaging in the HIA process, as well as carrying out their own HIA's. In addition, toolkits that have been developed to enhance community engagement will be included for review. The findings from the literature review will inform the conceptual framework for data collection for the HIAs. This framework will then be applied when involving communities in both HIAs, forming the conceptual content for data collection using the World Café method during the Analysis stage of the HIAs. Based on the findings from the application of the framework, which involves community participation during the Analysis stages of both HIAs, the Community Engagement Toolkit will be created. The Toolkit will be aimed at people who are doing HIAs and want guidance on community engagement, as well as guidance for community groups on engaging in HIAs. Data for work stream 3 will be drawn from work streams 1 and 2 of community representatives on the HIA Steering Groups, as well as part of the Analysis stage of the HIA.

Work stream 4: Iterative development of a contextualised, contemporary, Irish HIA implementation model by integrating and triangulating qualitative and quantitative data from all work streams (research objective 5)

Identified limitations in the literature will be addressed in HIA-IM including a scoping review of factors affecting HIA implementation, with a view to informing the development of the HIA implementation model. This scoping review will inform the integration of data from all work streams as well as the main output from the research study, the HIA implementation model. Contributions from the Public Involvement in the research study is crucial to the development of the HIA implementation model. This work stream 4 involves four Public Involvement events with the HIA-IM Public Involvement Consultation Group, in the first three years of the project, in order to gather contributions to inform the development of the model. In the fourth and final year of the project, a Public Forum event will be held in order to include further contributions from the public to the model, beyond the Consultation Group. This will ensure the model is both informed by scientific evidence together with contributions from the Public Involvement process.

Upon completion of both HIA 1 and HIA 2, data will be synthesised and analysed in order to iteratively build the contextualised Irish HIA implementation model. The research study will do this through a process that documents the implementation process in the conduct of two HIAs. Work stream 4 will consolidate the findings on impact and effectiveness of HIA 1 and HIA 2 (Task 1.1), themes emerging from Task 1.2, findings from work stream 2, findings from the creation of the Community Engagement Toolkit (work stream 3) and four PPI events (work stream 4) in order to produce the contextualised HIA implementation model.

Integration of data occurs at three stages in HIA-IM. The model will be produced iteratively as findings from HIA 1 will be integrated with findings from HIA 2 creating the report on the application of the action research cycle to HIA implementation. Integration will take place at the interpretation stage of the study, to triangulate findings. Specifically, triangulation will be carried out during the iterative and continual synthesis and integration stages, where a convergence coding matrix will be developed to display findings emerging from all work streams.

A central feature of the research study will be to ensure that research findings and outcomes are interpreted by the research team, staff of the Institute of Public Health Ireland (IPH), and relevant collaborators during research team, Steering Group and Advisory Panel meetings, and meetings with project collaborators. Contributions at PPI events will facilitate contributions to identify key priorities and recommendations, as well as co-production in data analysis, informing the model. The main outcome from work stream 4 will be the continual development of the HIA implementation model, which will be built iteratively and consistently throughout the project. This model will be populated by data findings from all work streams.

The HIA implementation model will include an explanation of the implementation of HIA at local policy level and national policy level, in order to uncover, enhance understanding and offer a guiding tool and process for doing HIAs in Ireland, at the policy, strategic level.

Results dissemination

As the action research approach is central to the study, results dissemination will be done in an iterative way during the conduct of both HIAs, with ongoing dissemination and learning to be carried out with both of the two HIA teams (Steering and Working Groups). There will be a variety of research dissemination outputs resulting from this research project including peer-reviewed journal articles, policy briefs, research papers, published dataset with the Irish Qualitative Data Archive (IQDA), and conference proceedings as a result of this research project. The translation of evidence to policy impact pathway inherent in the partnership between project team and leading health policy actors on the island of Ireland, namely the Institute of Public Health who are leading on the roll-out of the HIA programme and within the HSE, will influence the implementation of HIA on the island of Ireland. These publications will be disseminated through the School of Public Health and ISS21 websites, project partners, team members and academic networks. Results will be reported according to the COREQ guidelines as appropriate (Booth et al., 2014).

Study status

This research is currently underway.

Discussion

This research study is carried out using the expertise and experience of the PI and project team, who have a track record of high-quality research in HIA, implementation science, action research methodologies, environmental sociology, public activism, and Health in All Policies. The way in which the PI and project team have worked together has been collaborative from the start, designing the work programme in an iterative and consensual way before the project commenced and continuously, with key partners. Co-creation and co-production of the HIA on the Cork City Development Plan (2022–2028), of the HIA on the national Climate Action Plan (2024), Community Engagement Toolkit and HIA implementation model is at heart of the study’s work programme. Partnership working and co-creation across the research study will enhance understanding of HIA implementation processes and uncover the nuanced experience and power dynamics arising in the conduct of HIA. It will provide a guiding tool with the HIA implementation model to strengthen intersectoral approaches in tackling health inequalities and optimise health equity, as well as contribute to academic literature in the field.

Ethical approval and consent

Ethical approval was sought from the University College Cork, Social Research Ethics Committee (SREC) in May 2023, and secured in June 2023 (Ethics approval number: 2023-091). An ethics amendment was approved by SREC in December 2023, which included detail on the data collection instruments and a description of the Public Involvement process engaged in the project. This study protocol will be sent to SREC in UCC for their information and records. Primary data will be derived from interviews, questionnaires, World cafés, HIA group meeting minutes and researcher reflections. Participant information sheets, consent forms and Conflict of Interest statements were approved during the UCC ethics approval process.

Data availability

No data are associated with this article.

Acknowledgments

Professor Ivan Perry, School of Public Health, UCC, Ms Aoife Dorney of Makemake company for doing the graphic design work for Figure 1.

Faculty Opinions recommended

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Version 3

VERSION 3 PUBLISHED 20 Mar 2024

Author details Author details

Tara Kenny
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Visualization

Kirsty Nash
Roles: Formal Analysis, Methodology, Project Administration

Sheena M. McHugh
Roles: Conceptualization, Formal Analysis, Methodology

Paul Kavanagh
Roles: Conceptualization, Writing – Review & Editing

Katherine Smith
Roles: Conceptualization

Competing interests

No competing interests were disclosed.

Grant information

This work was supported by the Health Research Board [EIA-2022-001].

Article Versions (3)

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Published: 06 Feb 2025, 7:14

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© 2024 O'Mullane M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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O'Mullane M, Kenny T, Nash K et al. Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities- A Mixed Methods Study Protocol [version 1; peer review: 2 approved with reservations]. HRB Open Res 2024, 7:14 (https://doi.org/10.12688/hrbopenres.13873.1)

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Open Peer Review

Version 1

VERSION 1

PUBLISHED 20 Mar 2024

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Reviewer Report 20 May 2024

Courtney L McNamara, Newcastle University, Newcastle upon Tyne, England, UK

Approved with Reservations

https://doi.org/10.21956/hrbopenres.15209.r38902

The manuscript ‘Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities- A Mixed Methods Study Protocol’ discusses the development and implementation of a Health Impact Assessment (HIA) model aimed at enhancing intersectoral approaches to tackle health inequalities in Ireland. It employs a mixed methods research strategy incorporating action research and implementation science theories to develop a contextualized HIA Implementation Model. The study is structured around several work streams that address five objectives and includes the production of a Community Engagement Toolkit and dissemination strategies.

Overall, the study addresses a topical/pressing issue, using a robust methodological approach. The manuscript, however, is structured and written in a manner that might be confusing for readers. The transitions between sections are not always clear, and it can be challenging to discern the main objectives and rationale of the study’s methods.

The study’s aim for example is discussed in several places using different terminology. The authors might consider some restructuring so that that the aim (mentioned just once) flows directly from an introduction that introduces the research gap, followed by methods and results/conclusions. It would be helpful when outlining the research gap to also describe the rationale for action research and implementation science strategies broadly and for the specific frameworks that are being used.
Please check the numbering/characterization of the objectives on page 4 as the numbering system at the moment is a bit confusing and seems to list only 4 objectives.
Greater detail should be provided on the steering and working groups and who will be included in them.
Although the creation of a Community Engagement Toolkit is mentioned, there doesn’t seem to be a public component to the dissemination strategy.
Minor recommendation
P 3 The following sentence: Employment status and education is associated with people reporting ‘good or very good health’ in the Healthy Ireland survey (DOH, 2023; Duffy et al., 2022).”
Should be revised to mention that those who are employed and higher educated are more likely to report 'good or very good' health

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: My background is in public health and health equity and I have experience with HIAs

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 24 Dec 2024

Monica OMullane, School of Public Health, University College Cork, Cork, Ireland

24 Dec 2024

Author Response

Dear Courtney, Many thanks for this review.
The Aim mentioned now only in the ‘study aims and objectives section,’ following the introduction that introduces the research gap.
Rationale for using implementation ... Continue reading Dear Courtney, Many thanks for this review.
The Aim mentioned now only in the ‘study aims and objectives section,’ following the introduction that introduces the research gap.
Rationale for using implementation science and action research in the introduction, as well as rationale for why using the two IS frameworks.
Under the ‘Study aims and objectives section,’ the five research objectives are now listed.
Under the section ‘study aims and objectives,’ I’ve included details on the broad sectoral representation of who is on the steering groups.
This information is included now in the ‘results dissemination’ section- that the HIA reports, and the Community Engagement Toolkit will be stored on an open access repository and will be disseminate across networks including the HIA-IM Public Involvement Consultation Group.
Amended the sentence in the introduction section of the Protocol to read:
Those who are employed and higher educated are more likely to report 'good or very good' health ( DOH, 2023; Duffy et al., 2022).
Dear Courtney, Many thanks for this review.
The Aim mentioned now only in the ‘study aims and objectives section,’ following the introduction that introduces the research gap.
Rationale for using implementation science and action research in the introduction, as well as rationale for why using the two IS frameworks.
Under the ‘Study aims and objectives section,’ the five research objectives are now listed.
Under the section ‘study aims and objectives,’ I’ve included details on the broad sectoral representation of who is on the steering groups.
This information is included now in the ‘results dissemination’ section- that the HIA reports, and the Community Engagement Toolkit will be stored on an open access repository and will be disseminate across networks including the HIA-IM Public Involvement Consultation Group.
Amended the sentence in the introduction section of the Protocol to read:
Those who are employed and higher educated are more likely to report 'good or very good' health ( DOH, 2023; Duffy et al., 2022).
Competing Interests: No competing interests were disclosed. Close
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Author Response 24 Dec 2024

Monica OMullane, School of Public Health, University College Cork, Cork, Ireland

24 Dec 2024

Author Response

Dear Courtney, Many thanks for this review.
The Aim mentioned now only in the ‘study aims and objectives section,’ following the introduction that introduces the research gap.
Rationale for using implementation ... Continue reading Dear Courtney, Many thanks for this review.
The Aim mentioned now only in the ‘study aims and objectives section,’ following the introduction that introduces the research gap.
Rationale for using implementation science and action research in the introduction, as well as rationale for why using the two IS frameworks.
Under the ‘Study aims and objectives section,’ the five research objectives are now listed.
Under the section ‘study aims and objectives,’ I’ve included details on the broad sectoral representation of who is on the steering groups.
This information is included now in the ‘results dissemination’ section- that the HIA reports, and the Community Engagement Toolkit will be stored on an open access repository and will be disseminate across networks including the HIA-IM Public Involvement Consultation Group.
Amended the sentence in the introduction section of the Protocol to read:
Those who are employed and higher educated are more likely to report 'good or very good' health ( DOH, 2023; Duffy et al., 2022).
Dear Courtney, Many thanks for this review.
The Aim mentioned now only in the ‘study aims and objectives section,’ following the introduction that introduces the research gap.
Rationale for using implementation science and action research in the introduction, as well as rationale for why using the two IS frameworks.
Under the ‘Study aims and objectives section,’ the five research objectives are now listed.
Under the section ‘study aims and objectives,’ I’ve included details on the broad sectoral representation of who is on the steering groups.
This information is included now in the ‘results dissemination’ section- that the HIA reports, and the Community Engagement Toolkit will be stored on an open access repository and will be disseminate across networks including the HIA-IM Public Involvement Consultation Group.
Amended the sentence in the introduction section of the Protocol to read:
Those who are employed and higher educated are more likely to report 'good or very good' health ( DOH, 2023; Duffy et al., 2022).
Competing Interests: No competing interests were disclosed. Close
Report a concern

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Reviewer Report 13 Apr 2024

Marleen Bekker, Wageningen University & Research, Wageningen, Gelderland, The Netherlands

Approved with Reservations

https://doi.org/10.21956/hrbopenres.15209.r38898

The paper 'Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities- A Mixed Methods Study Protocol' offers a commendable approach to experiment with and reflect on implementation conditions for HIA and its conclusions and policy recommendations. Identifying an implementation gap of HIA into intersectoral policies and actions addressing health inequalities, the study sets out to experiment with a local and a national level HIA, using these as action research settings for exploring theory-driven as well as experience-based implementation conditions and co-developing with study participants an implementation model and a Community Engagement Toolkit. The authors argue that this design will also allow for critical assessment of whether HIA overall is fit for purpose.

The action research approach in my view offers important conditions to do justice to observed implementation barriers such as reflexive dialogues with HIA actors, affected groups and end users moving from evidence to meaning through joint sense-making and shared value creation, developing a common language and ambition horizon, as well as developing a shared understanding and sense of acceptability, feasibility and applicability of policy recommendations within the institutional frames and boundaries of voluntary coordination in that particular policy field. Actions that move beyond these boundaries require alternative strategies such as activism, advocacy or litigation. The reflection-in-action design could however take a broader approach, moving the development of a toolkit and a model towards developing conditions for a sustainable organizational infrastructure collecting policy feed forward and feedback for policy responsiveness and change, of which HIA can be an important partial component. This could institutionalize ownership in the non-health policy domain. It is of crucial importance to understand that implementation is not in the hands of HIA proponents, and ownership needs to be organized beyond the HIA.

On a more critical note, the study design reads as a rather technical approach to procedures of HIA and action research. Yet the study purposes of policy implementation and change are fundamentally political - whether at the micro, meso or macrolevel of government and its relations to society. Therefore the study design could benefit from adding an explicit framework for the analysis of power within and between governmental and societal actors and stakeholders. Understanding the political dynamics allows HIA proponents to leverage the access, voice and veto options in the political system in strategies additional to HIA to the benefit of the public's health. Why would this be important? Because HIA implementation cannot be enforced. We need to deeply understand the mechanisms of policy change apart from HIA in order to devise appropriate strategies.

Under policy and institutional conditions by which intersectoral policies and HIAs are 'endorsed' - and therefore in the absence of regulatory obligations, sanctions and enforcement, the coordination of such HIAs and their policy recommendations depends largely on voluntary mechanisms.Voluntary policy coordination and alignment across sectors, although often described as 'weak' or 'soft' mechanisms, rely on an ever growing repertoire of strategies, instruments, arrangements and networks that can produce strong and hard policy change to better promote and protect the health of affected groups or populations. However, such policy change usually does not result from a singular HIA but rather from intentional or unintentional combinations of strategies that significantly broaden the relevance to a larger and more powerful group, external events that induce contextual changes in public or political support, and/or shifts in power within the bureaucracy or in the political system. Any HIA initiative therefore could be more embedded in an approach to understand and act upon the complex adaptive system around the policy at hand. Secondly, HIA could become embedded in a sustainable learning infrastructure that connects operational, instrumental policy learning within a single HIA to organizational learning and adaptation of policymaking rules and procedures and to system level learning and change. The system level incorporates an infrastructure built around governmental monitoring and evaluation that makes policies more responsive to issues of legitimacy. Deeply understanding the politics of, for instance, permit procedures, practices, lobbying and (lack of) enforcement puts HIA in a different perspective. It might be helpful to use the action research design to develop a decision tool on what strategies would fit a variety of health impacts and purposes.

It might be interesting to further strengthen this study protocol in the literature with alternative considerations of the Health FOR All Policies model and a co-benefits approach towards a persuasive argumentation for policy change; and whole of society approaches for the convergence of health and economy - an anticipatory rather than reactive approach to state-society partnerships.

Some suggestions concern specific points in the use of theory and methods, these are listed here.
On the use of theory: the Normalisation Process Theory (NPT) and the Consolidated Framework for Implementation Research (CFIR): why and how did the authors select these two and how do these complement each other? The CFIR was not developed with a focus on public policies but, rather, to address organizational or professional policies that do not have to comply with or are not set according to democratic requirements.

Methods
- Although participation of key implementation actors and end users is mentioned under the Analysis stage of HIA, it is of crucial importance that implementation actors are already part of the study from the very first moments of designing the HIAs in the Steering and Working Groups.
- The protocol states that a conceptual framework for meaningful community engagement needs to be developed. The World Café offers an organizational procedure that might be enriched with for instance the technique of responsive evaluation (first developed by Robert Stake). Here the dialogue is owned and designed by participants. It focuses on sharing and understanding their issues, claims and concerns, articulating the controversies and avoiding premature consensus. This has been evaluated and proven highly effective in communities and stakeholders feeling heard, developing common understanding and offering increased engagement and alternative actions.
- I would suggest to replace the Stop and Share interview during the reporting and implementation stage with this World Café format since this seems a crucial stage to the study's purpose. Moreover, participants learn from each other enriching the model further.
- I am unfamiliar with the NoMAD questionnaire and it is unclear to me why participants would have to fill out this questionnaire three times, since this study does not have an experimental or longitudinal setup.
- the study protocol does not elaborate on the Cork City Development plan nor the national Climate Action plan. It is therefore unclear what specific conditions are relevant for the HIA as well as the action research design, and to what extent the implementation model and citizen engagement kit are generalizable to other policy proposals, geographic regions and population groups.
- The protocol does not address a theoretical framework for health inequalities. The design might benefit from using scientific publications on the Health Equity Impact Assessment toolkit.
- The study organization with for instance the Public Involvement Group is convincing to ensure co-creation and co-production with relevant stakeholders and community representatives. The quality however will depend on who will participate and the range of diversity represented. This is not specified yet.

Overall the protocol addresses an important and increasingly urgent issue of aligning policies to protect public health. However, the protocol is executed in a rapidly changing context with increasing uncertainties and pressures on democratic and governance stability. Moreover, climate change increasingly shows how human health in the complex ecosystem depends on environmental and planetary conditions. As a last suggestion, it might not suffice to focus the HIA implementation model and the community engagement toolkit on human health and human inequalities alone. The public health sector itself might consider going beyond human health to incorporate other living organisms affected by climate change, environmental health, biodiversity, and a circular economy as crucial risks and resources to human health.
Refer:
(PDF) The Politics of Healthy Policies: Redesigning health impact assessment to integrate health in public policy (researchgate.net)

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

References

1. Dubé L, Addy NA, Blouin C, Drager N: From policy coherence to 21st century convergence: a whole-of-society paradigm of human and economic development.Ann N Y Acad Sci. 2014; 1331: 201-215 PubMed Abstract | Publisher Full Text
2. Abma TA: Responsive evaluation in health promotion: its value for ambiguous contexts.Health Promot Int. 2005; 20 (4): 391-7 PubMed Abstract | Publisher Full Text
3. Sadare O, Williams M, Simon L: Implementation of the Health Equity Impact Assessment (HEIA) tool in a local public health setting: challenges, facilitators, and impacts.Can J Public Health. 2020; 111 (2): 212-219 PubMed Abstract | Publisher Full Text
4. Greer S, Bekker M, Azzopardi-Muscat N, McKee M: Political analysis in public health: middle-range concepts to make sense of the politics of health. European Journal of Public Health. 2018; 28 (suppl_3): 3-6 Publisher Full Text
5. Greer SL, Falkenbach M, Siciliani L, McKee M, et al.: From Health in All Policies to Health for All Policies.Lancet Public Health. 2022; 7 (8): e718-e720 PubMed Abstract | Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Transformative health governance; Health policy and politics; Global One Health

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Author Response 05 Jun 2024

Monica OMullane, School of Public Health, University College Cork, Cork, Ireland

05 Jun 2024

Author Response
Many thanks for your review and insightful comments and report.
The research is set within the context of the Health for all Policies realm, which we can include explicitly in ... Continue reading
Many thanks for your review and insightful comments and report.
The research is set within the context of the Health for all Policies realm, which we can include explicitly in the protocol. The setting theoretical domain of CFIR will capture the broader institutional and political context, and the extent to which is does that, will be reflected by us in the findings.
The research seeks to examine implementation processes, with a particular focus on the process of implementation, which NPT can theoretically capture, and the factors determining or shaping implementation of a specific approach, such as HIA, which is the validity of using CFIR. Both are well established implementation science frameworks and are often used together (for example- this article [Schroeder, D., Luig, T., Finch, T.L. et al. Understanding implementation context and social processes through integrating Normalization Process Theory (NPT) and the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun 3, 13 (2022). https://doi.org/10.1186/s43058-022-00264-8] looking to understand implementation context with CFIR and NPT). In the protocol, we can revise and clarify why we are using these chosen frameworks, and why together. Using these frameworks with HIA in mind as an innovative process is novel, and we seek to illustrate how and why the frameworks were useful, and also, if or when they were not applicable.
In response to queries regarding Methods used:

We are currently in the middle of data collection and therefore cannot change the Stop & Share for World Café; however, point duly noted for when planning HIA 2. What we are finding so far with doing the Stop & Shares at the various stages of the HIA is that there are revealing aspects of subjective experience of the process of the HIA that participants are reflecting in an open manner and this space seems to work well in their enabling their reflection during the ‘doing’ of the HIA.

NoMAD is a standardised survey developed from the domains of NPT; the reason for administering it three times during the process of data collection is to elicit data on how participants are experiencing the process of HIA at various stages of the HIA. Although not a longitudinal study, we are interested to see if there are any changes in the groups experience and involvement in the HIA.

We seek to detail the policies under study when we publish results. In these further papers and in the publication of the implementation model, we will detail to which extent is the protocol and subsequent model with toolkit generalizable to other policies, geographic regions and population groups.

We will review the design of the Community Engagement Toolkit to include design with scientific publications on the Health Equity Impact Assessment toolkit.
Many thanks for your review and insightful comments and report.
The research is set within the context of the Health for all Policies realm, which we can include explicitly in the protocol. The setting theoretical domain of CFIR will capture the broader institutional and political context, and the extent to which is does that, will be reflected by us in the findings.
The research seeks to examine implementation processes, with a particular focus on the process of implementation, which NPT can theoretically capture, and the factors determining or shaping implementation of a specific approach, such as HIA, which is the validity of using CFIR. Both are well established implementation science frameworks and are often used together (for example- this article [Schroeder, D., Luig, T., Finch, T.L. et al. Understanding implementation context and social processes through integrating Normalization Process Theory (NPT) and the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun 3, 13 (2022). https://doi.org/10.1186/s43058-022-00264-8] looking to understand implementation context with CFIR and NPT). In the protocol, we can revise and clarify why we are using these chosen frameworks, and why together. Using these frameworks with HIA in mind as an innovative process is novel, and we seek to illustrate how and why the frameworks were useful, and also, if or when they were not applicable.
In response to queries regarding Methods used:

We are currently in the middle of data collection and therefore cannot change the Stop & Share for World Café; however, point duly noted for when planning HIA 2. What we are finding so far with doing the Stop & Shares at the various stages of the HIA is that there are revealing aspects of subjective experience of the process of the HIA that participants are reflecting in an open manner and this space seems to work well in their enabling their reflection during the ‘doing’ of the HIA.

NoMAD is a standardised survey developed from the domains of NPT; the reason for administering it three times during the process of data collection is to elicit data on how participants are experiencing the process of HIA at various stages of the HIA. Although not a longitudinal study, we are interested to see if there are any changes in the groups experience and involvement in the HIA.

We seek to detail the policies under study when we publish results. In these further papers and in the publication of the implementation model, we will detail to which extent is the protocol and subsequent model with toolkit generalizable to other policies, geographic regions and population groups.

We will review the design of the Community Engagement Toolkit to include design with scientific publications on the Health Equity Impact Assessment toolkit.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Author Response 24 Dec 2024

Monica OMullane, School of Public Health, University College Cork, Cork, Ireland

24 Dec 2024

Author Response

More detail on responding to the review:

We will make it explicit in the protocol that when we refer to the implementation of HIA, we are referring to the ... Continue reading More detail on responding to the review:

We will make it explicit in the protocol that when we refer to the implementation of HIA, we are referring to the doing of HIA in practice: This is included now in the Introduction, and in the Methods section.

Under work stream 2 in the ‘methods section, I’ve made explicit that we are looking at HIA implementation with our research approach and using the outer and inner settings domains of CFIR to explore relevant policy or institutional drivers or levers.
Included Health for All Policies reference in the ‘introduction,’ where HiAP is first mentioned.
Included in the manuscript an explanation as to why we chose the two IS frameworks, why and how they complement each other. This is now in the Introduction section.

Included in the Methods section, in the Work Stream 2 section: I would argue that whilst yes, CFIR was not developed solely to focus on public polices, one of its five domains (Damschroder et al. 2022) in the originla and updated CFIR includes the outer setting, which includes policy relevant attributes such as Policies & Laws, Local Conditions, Local Attitudes and so on.
The information on Steering and Working Groups is included in the Methods section, under work stream one, task 1.1.
The reference for the NoMAD survey is included in the protocol (Finch et al. 2018), from my searching online, the Finch et al 92018) paper looks like the accepted published paper on the NoMAD survey/ questionnaire https://implementationoutcomerepository.org/implementation-outcomes/sustainability/normalisation-measure-development-questionnaire-nomad

Information included in the Methods section under Work Stream 2 in relation to rationale for repeating the administration of the survey.

More detail is provided on the two policies, namely, the Cork City Development Plan (2022-2028) and the Climate Action Plan (2024), specifying their remit and scope, geographic scope, and population groups.
Included now in the section:

Included the Health Equity Impact Assessment to the Work stream 3- Section.

Members of the HIA-IM public Involvement Consultation Group are included in the Introduction. Included a point on this in ‘results dissemination.’

I include reference to Bekker (2007) also.
More detail on responding to the review:

We will make it explicit in the protocol that when we refer to the implementation of HIA, we are referring to the doing of HIA in practice: This is included now in the Introduction, and in the Methods section.

Under work stream 2 in the ‘methods section, I’ve made explicit that we are looking at HIA implementation with our research approach and using the outer and inner settings domains of CFIR to explore relevant policy or institutional drivers or levers.
Included Health for All Policies reference in the ‘introduction,’ where HiAP is first mentioned.
Included in the manuscript an explanation as to why we chose the two IS frameworks, why and how they complement each other. This is now in the Introduction section.

Included in the Methods section, in the Work Stream 2 section: I would argue that whilst yes, CFIR was not developed solely to focus on public polices, one of its five domains (Damschroder et al. 2022) in the originla and updated CFIR includes the outer setting, which includes policy relevant attributes such as Policies & Laws, Local Conditions, Local Attitudes and so on.
The information on Steering and Working Groups is included in the Methods section, under work stream one, task 1.1.
The reference for the NoMAD survey is included in the protocol (Finch et al. 2018), from my searching online, the Finch et al 92018) paper looks like the accepted published paper on the NoMAD survey/ questionnaire https://implementationoutcomerepository.org/implementation-outcomes/sustainability/normalisation-measure-development-questionnaire-nomad

Information included in the Methods section under Work Stream 2 in relation to rationale for repeating the administration of the survey.

More detail is provided on the two policies, namely, the Cork City Development Plan (2022-2028) and the Climate Action Plan (2024), specifying their remit and scope, geographic scope, and population groups.
Included now in the section:

Included the Health Equity Impact Assessment to the Work stream 3- Section.

Members of the HIA-IM public Involvement Consultation Group are included in the Introduction. Included a point on this in ‘results dissemination.’

I include reference to Bekker (2007) also.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 05 Jun 2024

Monica OMullane, School of Public Health, University College Cork, Cork, Ireland

05 Jun 2024

Author Response
Many thanks for your review and insightful comments and report.
The research is set within the context of the Health for all Policies realm, which we can include explicitly in ... Continue reading
Many thanks for your review and insightful comments and report.
The research is set within the context of the Health for all Policies realm, which we can include explicitly in the protocol. The setting theoretical domain of CFIR will capture the broader institutional and political context, and the extent to which is does that, will be reflected by us in the findings.
The research seeks to examine implementation processes, with a particular focus on the process of implementation, which NPT can theoretically capture, and the factors determining or shaping implementation of a specific approach, such as HIA, which is the validity of using CFIR. Both are well established implementation science frameworks and are often used together (for example- this article [Schroeder, D., Luig, T., Finch, T.L. et al. Understanding implementation context and social processes through integrating Normalization Process Theory (NPT) and the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun 3, 13 (2022). https://doi.org/10.1186/s43058-022-00264-8] looking to understand implementation context with CFIR and NPT). In the protocol, we can revise and clarify why we are using these chosen frameworks, and why together. Using these frameworks with HIA in mind as an innovative process is novel, and we seek to illustrate how and why the frameworks were useful, and also, if or when they were not applicable.
In response to queries regarding Methods used:

We are currently in the middle of data collection and therefore cannot change the Stop & Share for World Café; however, point duly noted for when planning HIA 2. What we are finding so far with doing the Stop & Shares at the various stages of the HIA is that there are revealing aspects of subjective experience of the process of the HIA that participants are reflecting in an open manner and this space seems to work well in their enabling their reflection during the ‘doing’ of the HIA.

NoMAD is a standardised survey developed from the domains of NPT; the reason for administering it three times during the process of data collection is to elicit data on how participants are experiencing the process of HIA at various stages of the HIA. Although not a longitudinal study, we are interested to see if there are any changes in the groups experience and involvement in the HIA.

We seek to detail the policies under study when we publish results. In these further papers and in the publication of the implementation model, we will detail to which extent is the protocol and subsequent model with toolkit generalizable to other policies, geographic regions and population groups.

We will review the design of the Community Engagement Toolkit to include design with scientific publications on the Health Equity Impact Assessment toolkit.
Many thanks for your review and insightful comments and report.
The research is set within the context of the Health for all Policies realm, which we can include explicitly in the protocol. The setting theoretical domain of CFIR will capture the broader institutional and political context, and the extent to which is does that, will be reflected by us in the findings.
The research seeks to examine implementation processes, with a particular focus on the process of implementation, which NPT can theoretically capture, and the factors determining or shaping implementation of a specific approach, such as HIA, which is the validity of using CFIR. Both are well established implementation science frameworks and are often used together (for example- this article [Schroeder, D., Luig, T., Finch, T.L. et al. Understanding implementation context and social processes through integrating Normalization Process Theory (NPT) and the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun 3, 13 (2022). https://doi.org/10.1186/s43058-022-00264-8] looking to understand implementation context with CFIR and NPT). In the protocol, we can revise and clarify why we are using these chosen frameworks, and why together. Using these frameworks with HIA in mind as an innovative process is novel, and we seek to illustrate how and why the frameworks were useful, and also, if or when they were not applicable.
In response to queries regarding Methods used:

We are currently in the middle of data collection and therefore cannot change the Stop & Share for World Café; however, point duly noted for when planning HIA 2. What we are finding so far with doing the Stop & Shares at the various stages of the HIA is that there are revealing aspects of subjective experience of the process of the HIA that participants are reflecting in an open manner and this space seems to work well in their enabling their reflection during the ‘doing’ of the HIA.

NoMAD is a standardised survey developed from the domains of NPT; the reason for administering it three times during the process of data collection is to elicit data on how participants are experiencing the process of HIA at various stages of the HIA. Although not a longitudinal study, we are interested to see if there are any changes in the groups experience and involvement in the HIA.

We seek to detail the policies under study when we publish results. In these further papers and in the publication of the implementation model, we will detail to which extent is the protocol and subsequent model with toolkit generalizable to other policies, geographic regions and population groups.

We will review the design of the Community Engagement Toolkit to include design with scientific publications on the Health Equity Impact Assessment toolkit.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Author Response 24 Dec 2024

Monica OMullane, School of Public Health, University College Cork, Cork, Ireland

24 Dec 2024

Author Response

More detail on responding to the review:

We will make it explicit in the protocol that when we refer to the implementation of HIA, we are referring to the ... Continue reading More detail on responding to the review:

We will make it explicit in the protocol that when we refer to the implementation of HIA, we are referring to the doing of HIA in practice: This is included now in the Introduction, and in the Methods section.

Under work stream 2 in the ‘methods section, I’ve made explicit that we are looking at HIA implementation with our research approach and using the outer and inner settings domains of CFIR to explore relevant policy or institutional drivers or levers.
Included Health for All Policies reference in the ‘introduction,’ where HiAP is first mentioned.
Included in the manuscript an explanation as to why we chose the two IS frameworks, why and how they complement each other. This is now in the Introduction section.

Included in the Methods section, in the Work Stream 2 section: I would argue that whilst yes, CFIR was not developed solely to focus on public polices, one of its five domains (Damschroder et al. 2022) in the originla and updated CFIR includes the outer setting, which includes policy relevant attributes such as Policies & Laws, Local Conditions, Local Attitudes and so on.
The information on Steering and Working Groups is included in the Methods section, under work stream one, task 1.1.
The reference for the NoMAD survey is included in the protocol (Finch et al. 2018), from my searching online, the Finch et al 92018) paper looks like the accepted published paper on the NoMAD survey/ questionnaire https://implementationoutcomerepository.org/implementation-outcomes/sustainability/normalisation-measure-development-questionnaire-nomad

Information included in the Methods section under Work Stream 2 in relation to rationale for repeating the administration of the survey.

More detail is provided on the two policies, namely, the Cork City Development Plan (2022-2028) and the Climate Action Plan (2024), specifying their remit and scope, geographic scope, and population groups.
Included now in the section:

Included the Health Equity Impact Assessment to the Work stream 3- Section.

Members of the HIA-IM public Involvement Consultation Group are included in the Introduction. Included a point on this in ‘results dissemination.’

I include reference to Bekker (2007) also.
More detail on responding to the review:

We will make it explicit in the protocol that when we refer to the implementation of HIA, we are referring to the doing of HIA in practice: This is included now in the Introduction, and in the Methods section.

Under work stream 2 in the ‘methods section, I’ve made explicit that we are looking at HIA implementation with our research approach and using the outer and inner settings domains of CFIR to explore relevant policy or institutional drivers or levers.
Included Health for All Policies reference in the ‘introduction,’ where HiAP is first mentioned.
Included in the manuscript an explanation as to why we chose the two IS frameworks, why and how they complement each other. This is now in the Introduction section.

Included in the Methods section, in the Work Stream 2 section: I would argue that whilst yes, CFIR was not developed solely to focus on public polices, one of its five domains (Damschroder et al. 2022) in the originla and updated CFIR includes the outer setting, which includes policy relevant attributes such as Policies & Laws, Local Conditions, Local Attitudes and so on.
The information on Steering and Working Groups is included in the Methods section, under work stream one, task 1.1.
The reference for the NoMAD survey is included in the protocol (Finch et al. 2018), from my searching online, the Finch et al 92018) paper looks like the accepted published paper on the NoMAD survey/ questionnaire https://implementationoutcomerepository.org/implementation-outcomes/sustainability/normalisation-measure-development-questionnaire-nomad

Information included in the Methods section under Work Stream 2 in relation to rationale for repeating the administration of the survey.

More detail is provided on the two policies, namely, the Cork City Development Plan (2022-2028) and the Climate Action Plan (2024), specifying their remit and scope, geographic scope, and population groups.
Included now in the section:

Included the Health Equity Impact Assessment to the Work stream 3- Section.

Members of the HIA-IM public Involvement Consultation Group are included in the Introduction. Included a point on this in ‘results dissemination.’

I include reference to Bekker (2007) also.
Competing Interests: No competing interests were disclosed. Close
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Version 3

VERSION 3 PUBLISHED 20 Mar 2024

Open Peer Review

Reviewer Status

Reviewer Reports

	Invited Reviewers
	1	2	3
Version 3 (revision) 06 Feb 25		read	read
Version 2 (revision) 24 Dec 24	read
Version 1 20 Mar 24	read	read

Marleen Bekker, Wageningen University & Research, Wageningen, The Netherlands
Courtney L McNamara, Newcastle University, Newcastle upon Tyne, UK
Morufu Olalekan Raimi, Federal University Otuoke, Otuoke, Nigeria

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Reviewer Report

7 Views

25 Feb 2025 | for Version 3

Morufu Olalekan Raimi, Federal University Otuoke, Otuoke, Bayelsa, Nigeria

7 Views Cite this report Responses(0)

Approved With Reservations

HRB Open Research

The theme “Development of a Health Impact Assessment Implementation Model” is an essential contribution to public health and policy implementation. The study aligns with Health in All Policies (HiAP) and intersectoral governance models. Also, the integration of action research and implementation science frameworks by global HIA best practices and frameworks. The research has direct applications in policy implementation and public health interventions. Although, the model could be adapted for other countries looking to strengthen HIA frameworks. Using AI-driven data analysis could enhance HIA implementation and scalability and the study can inform urban planning, climate policy, and social justice initiatives. However, the manuscript requires several improvements for a clearer and stronger impact.

The title is informative, appropriate, clear and concise, effectively summarizing the research focus. However, it will be better featured as “A Health Impact Assessment Implementation Model for Policy Integration.”
The abstract is well-structured. however, the abstract should emphasize how this model advances existing HIA practices.

Rationale: The abstract outlines the importance of HIA but does not adequately highlight the limitations of existing models.
Objective: Clearly stated, but it should mention how the study builds on previous HIA research.
Methods: The methodology is well-articulated, but more details on the research frameworks used (e.g., CFIR, NPT) should be included. The proposed model is not tested in multiple policy environments to verify its robustness.
Results: The abstract should provide a more structured summary of the key innovations of the model.
Conclusions: Should emphasize the applicability of the model to different policy settings.
Recommendations: The abstract should outline how policymakers can apply this model in practice.

Keywords are appropriate
The introduction provides good background and contextualizes HIA within health policy but needs a clearer statement of research gaps.
The manuscript should better articulate why previous HIA models have been insufficient.
Author should avoid First-Person Pronouns: The author should replace “we” with “this study” or “the present study.”
Methodology - More details on participant recruitment and selection criteria should be included. The methodology should elaborate on data triangulation techniques to enhance validity.
Ethical considerations should be expanded, especially regarding community participation.
Results - Clearly structured and well-detailed with model development process.
Needs stronger comparisons with international HIA models.
Author should further discuss barriers to implementation and real-world applicability.
Figures need to better illustrate the implementation model.
Tables should be referenced more frequently in the text.
Discussion - The manuscript does not sufficiently discuss political and institutional barriers to HIA adoption. The study would also benefit from comparisons with HIA models in different policy contexts (e.g., EU vs. North America).
There are few grammatical errors and spelling mistakes in this article. The author should limit the use of personal pronounces and the use of “we” and “our” in the article. Use third person pronoun and past tense in the write up of the article. Reread this article for typographical, grammar and spelling errors.
Heavy Use of Technical Language – The manuscript could be clearer for a multidisciplinary audience.
Conclusion – Well-structured but should include policy implications.

Author needs a stronger statement on policy recommendations and long-term monitoring.

References – Comprehensive but needs more international case studies. Need more recent citations (2020–2024) and ensure consistent formatting (APA/Harvard style).

Specific Reviewer Comments and Suggestions:

Please give a frank account of the strengths and weaknesses of the article (in 100-200 words)

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Health Impact Assessment; Environmental Impact Assessment; Environmental Epidemiology; Climate Change and Health; Medical Geography; Pollution Control Management; Waste Management and Health etc.

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Reviewer Report

4 Views

25 Feb 2025 | for Version 3

Courtney L McNamara, Newcastle University, Newcastle upon Tyne, England, UK

4 Views Cite this report Responses(0)

Approved

The authors' revisions have addressed my concerns, and I am happy to update the status of the article to approved without reservations.

Competing Interests

No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

1 Views

29 Jan 2025 | for Version 2

Marleen Bekker, Wageningen University & Research, Wageningen, Gelderland, The Netherlands

1 Views Cite this report Responses(0)

Approved

The detailed response and the summary it looks like the authors have sufficiently processed the comments and suggestions in the new version.

Competing Interests

No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

17 Views

20 May 2024 | for Version 1

Courtney L McNamara, Newcastle University, Newcastle upon Tyne, England, UK

17 Views Cite this report Responses(1)

Approved With Reservations

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

My background is in public health and health equity and I have experience with HIAs

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Author Response

24 Dec 2024

Monica OMullane, School of Public Health, University College Cork, Cork, Ireland

Dear Courtney, Many thanks for this review.
The Aim mentioned now only in the ‘study aims and objectives section,’ following the introduction that introduces the research gap.
Rationale for using implementation science and action research in the introduction, as well as rationale for why using the two IS frameworks.
Under the ‘Study aims and objectives section,’ the five research objectives are now listed.
Under the section ‘study aims and objectives,’ I’ve included details on the broad sectoral representation of who is on the steering groups.
This information is included now in the ‘results dissemination’ section- that the HIA reports, and the Community Engagement Toolkit will be stored on an open access repository and will be disseminate across networks including the HIA-IM Public Involvement Consultation Group.
Amended the sentence in the introduction section of the Protocol to read:
Those who are employed and higher educated are more likely to report 'good or very good' health ( DOH, 2023; Duffy et al., 2022).

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

27 Views

13 Apr 2024 | for Version 1

Marleen Bekker, Wageningen University & Research, Wageningen, Gelderland, The Netherlands

27 Views Cite this report Responses(2)

Approved With Reservations

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

References

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Transformative health governance; Health policy and politics; Global One Health

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Responses (2)

Author Response

05 Jun 2024

Monica OMullane, School of Public Health, University College Cork, Cork, Ireland

Many thanks for your review and insightful comments and report.
The research is set within the context of the Health for all Policies realm, which we can include explicitly in the protocol. The setting theoretical domain of CFIR will capture the broader institutional and political context, and the extent to which is does that, will be reflected by us in the findings.
The research seeks to examine implementation processes, with a particular focus on the process of implementation, which NPT can theoretically capture, and the factors determining or shaping implementation of a specific approach, such as HIA, which is the validity of using CFIR. Both are well established implementation science frameworks and are often used together (for example- this article [Schroeder, D., Luig, T., Finch, T.L. et al. Understanding implementation context and social processes through integrating Normalization Process Theory (NPT) and the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun 3, 13 (2022). https://doi.org/10.1186/s43058-022-00264-8] looking to understand implementation context with CFIR and NPT). In the protocol, we can revise and clarify why we are using these chosen frameworks, and why together. Using these frameworks with HIA in mind as an innovative process is novel, and we seek to illustrate how and why the frameworks were useful, and also, if or when they were not applicable.
In response to queries regarding Methods used:

We are currently in the middle of data collection and therefore cannot change the Stop & Share for World Café; however, point duly noted for when planning HIA 2. What we are finding so far with doing the Stop & Shares at the various stages of the HIA is that there are revealing aspects of subjective experience of the process of the HIA that participants are reflecting in an open manner and this space seems to work well in their enabling their reflection during the ‘doing’ of the HIA.
NoMAD is a standardised survey developed from the domains of NPT; the reason for administering it three times during the process of data collection is to elicit data on how participants are experiencing the process of HIA at various stages of the HIA. Although not a longitudinal study, we are interested to see if there are any changes in the groups experience and involvement in the HIA.
We seek to detail the policies under study when we publish results. In these further papers and in the publication of the implementation model, we will detail to which extent is the protocol and subsequent model with toolkit generalizable to other policies, geographic regions and population groups.
We will review the design of the Community Engagement Toolkit to include design with scientific publications on the Health Equity Impact Assessment toolkit.

View more View less

Competing Interests

No competing interests were disclosed.

Author Response

24 Dec 2024

Monica OMullane, School of Public Health, University College Cork, Cork, Ireland

More detail on responding to the review:

We will make it explicit in the protocol that when we refer to the implementation of HIA, we are referring to the doing of HIA in practice: This is included now in the Introduction, and in the Methods section.

Under work stream 2 in the ‘methods section, I’ve made explicit that we are looking at HIA implementation with our research approach and using the outer and inner settings domains of CFIR to explore relevant policy or institutional drivers or levers.
Included Health for All Policies reference in the ‘introduction,’ where HiAP is first mentioned.
Included in the manuscript an explanation as to why we chose the two IS frameworks, why and how they complement each other. This is now in the Introduction section.

Included in the Methods section, in the Work Stream 2 section: I would argue that whilst yes, CFIR was not developed solely to focus on public polices, one of its five domains (Damschroder et al. 2022) in the originla and updated CFIR includes the outer setting, which includes policy relevant attributes such as Policies & Laws, Local Conditions, Local Attitudes and so on.
The information on Steering and Working Groups is included in the Methods section, under work stream one, task 1.1.
The reference for the NoMAD survey is included in the protocol (Finch et al. 2018), from my searching online, the Finch et al 92018) paper looks like the accepted published paper on the NoMAD survey/ questionnaire https://implementationoutcomerepository.org/implementation-outcomes/sustainability/normalisation-measure-development-questionnaire-nomad

Information included in the Methods section under Work Stream 2 in relation to rationale for repeating the administration of the survey.

More detail is provided on the two policies, namely, the Cork City Development Plan (2022-2028) and the Climate Action Plan (2024), specifying their remit and scope, geographic scope, and population groups.
Included now in the section:

Included the Health Equity Impact Assessment to the Work stream 3- Section.

Members of the HIA-IM public Involvement Consultation Group are included in the Introduction. Included a point on this in ‘results dissemination.’

I include reference to Bekker (2007) also.

View more View less

Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities- A Mixed Methods Study Protocol

Abstract

Keywords

Introduction

Study aims and objectives

Study design

Methods

Work stream 1: Action research-led design and implementation of two HIAs using revised national HIA guidance. HIA 1 on the Cork City Development Plan (2022–2028) and HIA 2 and on the Irish Government Climate Action Plan (2024)

Figure 1. Proposed research framework, drawing on the action research cycle employed by Archibong et al. (2017).

Work stream 2: Identification of factors that influence the process of HIA implementation, drawing from the Normalisation Process Theory (NPT) and the Consolidated Framework for Implementation Research (CFIR) (research objective 3) (Figure 1, green stream)

Work stream 3- Co-produce a Community Engagement Toolkit in order to optimise community participation in HIA in Ireland (research objective 4)

Work stream 4: Iterative development of a contextualised, contemporary, Irish HIA implementation model by integrating and triangulating qualitative and quantitative data from all work streams (research objective 5)

Results dissemination

Study status

Discussion

Ethical approval and consent

Data availability

Acknowledgments

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Are you a HRB-funded researcher?

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Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities- A Mixed Methods Study Protocol

Abstract

Keywords

Introduction

Study aims and objectives

Study design

Methods

Work stream 1: Action research-led design and implementation of two HIAs using revised national HIA guidance. HIA 1 on the Cork City Development Plan (2022–2028) and HIA 2 and on the Irish Government Climate Action Plan (2024)

Figure 1. Proposed research framework, drawing on the action research cycle employed by Archibong et al. (2017).

Work stream 2: Identification of factors that influence the process of HIA implementation, drawing from the Normalisation Process Theory (NPT) and the Consolidated Framework for Implementation Research (CFIR) (research objective 3) (Figure 1, green stream)

Work stream 3- Co-produce a Community Engagement Toolkit in order to optimise community participation in HIA in Ireland (research objective 4)

Work stream 4: Iterative development of a contextualised, contemporary, Irish HIA implementation model by integrating and triangulating qualitative and quantitative data from all work streams (research objective 5)

Results dissemination

Study status

Discussion

Ethical approval and consent

Data availability

Acknowledgments

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Competing Interests Policy

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Are you a HRB-funded researcher?

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