Exploring health equity integration among health service and delivery systems in Nova Scotia: Perspectives of health system partners

Abstract

Background Achieving health equity is important to improve population health; however, health equity is not typically well defined, integrated, or measured within health service and delivery systems. To improve population health provincially, it is necessary to understand barriers and facilitators to health equity integration within health service and delivery systems. This study aimed to explore health equity integration among health systems workers and identify key barriers and facilitators to implementing health equity strategies within the health service and delivery system in Nova Scotia, ahead of the release of a Health Equity Framework, focused on addressing inequities within publicly funded institutions. Methods Purposive sampling was used to recruit individuals working on health equity initiatives including those in high-level leadership positions within the Nova Scotia health system. Individual interviews and a focus group session were conducted. Topics of discussion included current integration of health equity through existing strategies and perceptions within participant roles. The Consolidated Framework for Implementation Research was used to guide coding and analysis, with interviews transcribed and deductively analyzed in NVivo. Qualitative description was employed to describe study findings as barriers and facilitators to health equity integration. Results Eleven individual interviews and one focus group (n = 5 participants) were conducted, with a total of 16 participants. Half (n = 8) of the participants were High-level Leaders (i.e., manager or higher) within the health system. We found that the CFIR subdomains of Complexity, Innovation Design, Mission Alignment, Available Resources and Roles: Mid and High-level leaders were barriers to health equity integration. The perceived homogeneity of leadership and therefore their capability to understand health equity accounted for the identification of leaders as a barrier. Facilitators for health equity integration included the subdomains Partnerships and Connections, Policies and Laws, and Engagement as a multi-domain facilitator. Existing strategies within the health system were found to be inadequate to address inequities. Conclusion Our findings suggest that health equity integration needs to be prioritized within the health service and delivery system within Nova Scotia and identifies possible strategies for implementation. Appropriate measures and training resources need to be put in place to support health equity integration.