Intersectoral Practice Research Articles

'It doesn't happen any other way': relationship-building and reflexivity for equity-focused intersectoral practice (EquIP).

Intersectoral processes that bring together public institutions, civil society organizations and affected community members are essential to tackling complex health equity challenges. While conventional wisdom points to the importance of human relationships in fostering collaboration, there is a lack of practical guidance on how to do intersectoral work in ways that support authentic relationship-building and mitigate power differentials among people with diverse experiences and roles. This article presents the results of RentSafe EquIP, a community-based participatory research initiative conducted in Owen Sound, Canada, in the midst of a housing crisis. The research explored the potential utility of equity-focused intersectoral practice (EquIP), a novel approach that invests in human relationships and knowledge co-creation among professionals and affected members of the community. The three-phase EquIP methodology centred the grounded expertise of community members with lived/living experience of housing inadequacy to catalyze reflexive thinking by people in professional roles about the institutional gaps and barriers that prevent effective intersectoral response to housing-related inequities. The research demonstrated that EquIP can support agency professionals and community members to (i) engage in (re)problematization to redefine the problem statement to better include upstream drivers of inequity, (ii) support reflexivity among those in professional roles to identify institutional practices, policies and norms that perpetuate stigma and impede effective intersectoral response and (iii) spark individual and collective agency and commitment towards a more equity-focused intersectoral system. We conclude that the EquIP methodology is a promising approach for communities seeking to address persistent health equity and social justice challenges.

Lessons from a rural housing crisis: grounded insights for intersectoral action on health inequities

Local communities are struggling with persistent health inequities driven by income disparity, housing inadequacy, and other intersecting factors that constrain individual and community well-being. Increasingly, intersectoral approaches are recognized as essential to tackle such challenges, given their intersecting nature. This paper describes Equity-focused Intersectoral Practice (EquIP), a novel methodology that merges participatory research principles with the purposeful positioning of grounded expertise (lived experience) to shift the gaze of intersectoral actors towards the contextual factors that contribute to health inequities. The EquIP methodology creates uncommon spaces for intersectoral encounter that support critical reflexivity and relationship-building among institutional and community-based intersectoral actors. A case example of the EquIP methodology, implemented in a small, rural Canadian city in the context of a regional housing crisis, illustrates how investment in reflexivity and relational praxis among diverse intersectoral actors supports the identification of existing structures, beliefs, and practices within institutional settings that constrain effective intersectoral response to health inequities.

Inter-sectoral work practice in Zimbabwe: Professional competencies required by occupational therapists to facilitate work participation of persons with disabilities

Background Persons with disabilities experience higher unemployment rates and limited participation in work. Occupational therapy can promote participation and engagement in work by persons with disabilities. However, there is no clarity on the required set of competencies for entry-level occupational therapists with a bachelor’s degree to start up and participate in inter-sectoral work practice initiatives in Zimbabwe. Aims To explore what work practice competencies entry-level occupational therapists require to meet the work-related needs of persons with disabilities. Material and Methods This exploratory qualitative research sought to explore what professional competencies entry-level occupational therapists required for them to offer collaborative inter-sectoral work practice initiatives for persons with disabilities within the Zimbabwean context. Six participants selected using criterion sampling, participated in semi-structured interviews. Inductive content analysis was conducted. The Stellenbosch Health Research Ethics Committee and Medical Rehabilitation Practitioner’s Council of Zimbabwe gave ethical clearance and permissions to conduct the study. Results Three themes; core knowledge for work practice, skills for work practice and occupational therapy professional attributes; emerged. These were used in formulation of ten professional competency statements for occupational therapists offering work practice services. Conclusions Although Zimbabwean occupational therapists require similar competencies for work practice as those required in other countries, additional competencies that fall outside traditional health care contexts are essential in order to promote contextually relevant practice.

Linking process and effects of intersectoral action on local neighbourhoods: systemic modelling based on Actor-Network Theory.

After 25years of intersectoral practice to increase health promotion resources, there is little scientific literature linking analysis of processes to observation of effects. Applying Actor-Network Theory, this article examines how the effects of intersectoral action are produced and can be attributed to its processes. A prospective multiple case study (2013-2016) was conducted on Neighbourhood Committees (NCs) in Montreal (Canada). Three NCs were studied using four kinds of data: direct observation notes of meetings and events, documents, logbooks and interviews. Systemic modelling of local intersectoral action was used for data collection and analysis. The results show that the transformations in living environments were produced by sequences of a limited number of 'transitory outcomes' that mark the progression of intersectoral action up to its effects. The list of transitory outcomes identified make up three functions in the production of change: (i) network setup and governance; (ii) self-representing and influencing others; (iii) aligning necessary actors and resources. The production of effects follows a systemic model wherein unique configurations of transitory outcomes, adapted to the different contexts where interactions are occurring, represent the change processes that lead to the effects.

Towards equity-focused intersectoral practice (EquIP) in children\u2019s environmental health and housing: the transformational story of RentSafe

SettingThis paper chronicles the transformational process through which a national intersectoral collaboration, the Canadian Partnership for Children’s Health and Environment (CPCHE), came to embrace a more upstream, equity-based focus in its mandate to advance children’s environmental health.InterventionAfter 15 years of working within a conventional, evidence-informed approach to health promotion and policy advocacy, in 2010–2013, CPCHE had the opportunity to collaborate on the development of equity-focused knowledge translation (EqKT). EqKT is a relational approach to knowledge practices that challenges intersectoral actors to work to uncover biases and limitations within their own institutional paradigms and professional practices that constrain their capacity to address population health inequities.OutcomeThe ensuing transformation towards equity-focused intersectoral practice led CPCHE to create an intersectoral initiative called RentSafe. Conceptually and operationally, RentSafe provides an intersectoral space within which the grounded expertise of people with experience of unhealthy and undignified housing provides a roadmap for public health and other practitioners to critically explore professional and institutional blind spots and barriers. With RentSafe as its watershed moment, CPCHE is shifting from a top-down “for whom” orientation to an authentically engaged “with whom” approach that seeks to work integrally with community partners to expose and challenge systemic roots of health inequity.ImplicationsThe transformational story of CPCHE underscores the competencies needed for public health professionals to acknowledge the sources of our own biases and limitations as a necessary first step in equity-focused intersectoral practice (EquIP). It also affirms the value of working in partnership with those who experience the environmental health inequities that such efforts seek to address.

Adolescent health promotion and the School Health Program: complexity in the articulation of health and education.

Objective To analyze the context of health promotion with adolescents in the health and education interface focusing on the actions of the Brazilian School Health Program. Qualitative study conducted in 2015 with professionals working in the Regional Executive Coordination IV, in Fortaleza, Ceará. The data obtained in the interview were processed in the ALCESTE program. 17 health professionals and 22 education professionals participated in the study. The organization of spontaneous demand causes disharmony in the scheduled visits and health actions in the school. The difficulties in the implementation of the School Health Program were demonstrated by the lack of knowledge, the lack of planning among the sectors and the different demarcations in the territory. The professionals' lack of knowledge regarding the program and the lack of action planning confirm the disarticulation of the education and health sectors, although they indicate the possibilities of this inter-sectoral practice.

Portugués

O estudo descreve conteúdos de ensino que podem contribuir para o desenvolvimento de novas competências em Educação Física (EF) e de novas formas de intervenções em Promoção da Saúde - PS e Qualidade de Vida - QV, dentro e fora da escola. As categorias aplicadas referem-se às dimensões e facetas do WHOQOL (World Health Organization Quality of Life) e ao conceito de corporeidade. Foi aplicado o método da triangulação que comparou artigos e documentos sobre a as demandas de formação destes profissionais, além dos resultados de uma pesquisa de campo. Concluiu-se que estes construtos requerem prática inter setorial, conhecimento interdisciplinar e mudanças na formação profissional. Sugere que a nova abordagem curricular estimule as novas formas de intervenção nos níveis políticos, stratégicos e tático-operacionais e sejam aplicados tanto no Bacharelado quanto na Licenciatura em EF.

A theoretical framework on intersectoral practice in School Health Promotion.

Resumo Trata-se de um estudo sobre os referenciais teóricos que influenciaram os programas de saúde escolar no Brasil, apoiada na experiência do Rio de Janeiro. Utiliza da literatura brasileira desde meados do século passado até o presente e da internacional sobre a avaliação em promoção da saúde. Analisam-se as propostas de domesticação de comportamentos a partir de princípios higienistas, outras empenhadas na criação de uma disciplina específica sobre saúde no currículo escolar, e ainda aquelas apoiadas em perspectiva clínico-assistencial. Em período mais recente analisa a reaproximação dos dois setores a partir de um modelo vinculado à promoção da saúde. O artigo demonstra a importância dos diferentes referenciais teóricos para a compreensão das ações e estratégias sintetizadas em uma matriz. Explicita, ainda, a influência dos contextos históricos em que se dá o diálogo e a definição de ações entre educação e saúde em uma difícil articulação de práticas e saberes entre os dois setores.

As ações intersetoriais na Estratégia de Saúde da Família: um estudo da representação do conceito de saúde e de suas práticas na Atenção Básica

Objetivo: Analisar a dinâmica das ações intersetoriais presentes na Estratégia de Saúde da Família a partir de um território, na cidade do Recife. Método: Pesquisa qualitativa, adotando o referencial teórico da produção social da saúde e a entrevista semiestruturada como instrumento de coleta dos dados aplicado aos profissionais que compõem equipes de saúde da família e profissionais que compõem serviços de referência do território investigado, tendo a teoria de Bardin como base para realização da análise de conteúdo. Resultados: Obtém-se a noção de saúde perpassando os múltiplos aspectos que envolvem a vida humana e o conceito de intersetorialidade distante das agendas dos serviços, refletindo uma prática intersetorial também deficitária. Conclusão: Possibilidades de práticas de diálogos entre os setores emergiram como caminhos possíveis dentro e fora do setor saúde como forma de superação dos problemas.

Bullying entre pares na escola: desafio aos enfermeiros que atuam na atenção básica à saúde

Bullying entre pares na escola: desafio aos enfermeiros que atuam na atenção básica à saúde

Network analysis as a tool to assess the intersectoral management of health determinants at the local level: A report from an exploratory study of two Cuban municipalities

Intersectoral action on health determinants has long been recognized as an important factor in achieving better population health. Nevertheless, there is no process that provides empirical evidence to policy-makers on the extent of intersectoral collaboration. We aimed to fill this gap by conducting case studies in two municipalities in Cuba, a country well known for its intersectoral practice and good health outcomes. We surveyed an intentional sample of key members of Health Councils - virtual intersectoral spaces in Cuba - about links and related actions they had with other sectors on eleven health determinants. Using network analysis we were able to produce measures to evaluate and characterize the network of sectors. Findings show that the two municipalities were similar in reported importance of health determinants, extent of long-term engagement in intra-sectors actions and level of collaboration with other sectors for virtually all determinants. Municipalities also showed similar overall levels of collaboration for most determinants when considered as a network of different sectors (network density). However municipalities showed differences in the central role played by some sectors (centrality index). We further used the network analysis blockmodeling technique to typify the municipal Health Councils. We found that while one Health Council can be typified by a single well connected network structure, the other has two distinct structures with more sparse connections. We conclude that intersectoral collaboration can be assessed by the use of network analysis measurements. This approach is novel and provides evidence to decision-makers about their role and their effort towards collaboration in achieving better health outcomes.

Health services organization according to the intersectoral perspective: a review

This text presents some reflections upon organizing, programming and structuring health services, according to the perspective that involves the challenges of an intersectoral practice, based upon the comprehension of the concept of health in the scenarios of health care practice. Health care is understood here as its amplified concept of quality of life. There is a consensus that the current care model, beyond its exclusive characteristic, presents a low impact upon the health care problems and the quality of life of society. Therefore, we look to base this study upon the work of authors who have amplified the strategic vision of organizing health care services in order to make such discussion the object of this study. Intersectoral practice, however, as an organizational strategy, looks to overcome policy fragmentation upon considering the human being in its entirety and its complexity.

Organização dos serviços de saúde na perspectiva da Intersetorialidade: limites e possibilidades da prática integralizadora

This text presents some reflections upon organizing, programming and structuring health services, according to the perspective that involves the challenges of an intersectoral practice, based upon the comprehension of the concept of health in the scenarios of health care practice. Health care is understood here as its amplified concept of quality of life. There is a consensus that the current care model, beyond its exclusive characteristic, presents a low impact upon the health care problems and the quality of life of society. Therefore, we look to base this study upon the work of authors who have amplified the strategic vision of organizing health care services in order to make such discussion the object of this study. Intersectoral practice, however, as an organizational strategy, looks to overcome policy fragmentation upon considering the human being in its entirety and its complexity.