Formulating Initial Programme Theories of the Healthy Homes and Neighbourhoods Integrated Care Initiative

John G. Eastwood; Ferdinand C. Mukumbang; Denise De Souza; Hueiming Liu; Erin Miller

doi:10.5334/ijic.6421

Figures & Tables

Iterative process toward developing the initial programme theories.

Potential information gleaned from exploring the theories of change (Adapted from Eastwood [7] and Kabongo et al. [23]).

Illustrates the results of the exercises of this step.

Table 2

Consumer-level CIMO elements.

PROGRAMME MODALITY	CONTEXT	MECHANISM	OUTCOME
Accessibility	Consumer characteristics: – Vulnerability – (Dis)trust in health services Programme characteristics: – Home Visiting – Place-based initiatives Health system characteristics: – Inflexibility	– Family – peer trust – Provider sharing between providers and consumers – shared responsibility – Building of self-help skills – self-efficacy and motivation	– Consumers’ improved access to care – Service engagement
Referral pathways Early intervention and public health approaches to interrupting cycles of family disadvantage, poor health and psychological trauma	Consumer characteristics: – Vulnerability: Complexity of consumer’s problem – consumers’ past experiences with services and willingness to give the service provider a chance Programme characteristics: – Home Visiting – Place-based initiatives Health system characteristics: – Complex	– Sharing of information – knowledge acquisition and encouragement	– Effective engagement of consumers – Consumers’ improved access to care – Consumer outlook improved
Accompaniment Co-design and co-production of the initiative in partnership with families and service partners	Consumer characteristics: – Vulnerability – Disconnected from health services Programme characteristics: – Programme flexibility – Providers taking dual roles	– Provider sharing between providers and consumers – shared responsibility – Family–provider trust	– Consumer independence – Effective engagement of consumers – Consumers’ improved access to care – Consumer outlook improved
Case-based discussions: Encouraging families for all their health needs and supporting progress towards self-efficacy (I)	Consumer characteristics: – Vulnerability – Disconnected from health services Programme characteristics: – Programme flexibility – Providers taking dual roles	– Family – peer trust – Sharing between providers and consumers – shared responsibility – Sharing of information – knowledge acquisition and encouragement – Building of self-help skills – self-efficacy and motivation	– Effective engagement of consumers – Consumer priorities are reflected in initial goal setting

Table 3

Service provider-level CIMO elements.

CHARACTERISTIC OF PROGRAMME	CONTEXT	MECHANISM	OUTCOME
Family identification: Development and implementation of shared assessment tools and referral criteria	Consumer characteristics: – Level of trust between: – Consumer and index caseworker – Consumer’s family members and – caseworker – professionals involved (C) Programme characteristics: – Home Visiting – Place-based initiatives	– Multiple modes of communication – Perceived benefits of collaboration	Service engagement
Accompaniment/intensive hand holding	Consumer characteristics: – Vulnerability – Disconnected from health services Programme characteristics: – Programme flexibility – Providers taking dual roles	– Service providers share information and power – shared responsibility – Shared policies, standards, protocols – buy-in – Shared assessment tools – buy-in	Improved quality of service delivered
Evidence-based practice	Consumer characteristics: – Vulnerability – Diversity of age and social, cultural and health background Programme characteristics: – Flexibility	– Experienced clinicians – Leveraging pre-existing experiences – knowledge of local services – Experiential learning	– Improved quality of service delivered
Navigation of the health system	Health system characteristics: – Complex consumer characteristics – Poor health literacy – Distrust of health services	Experienced clinician – knowledge of local services – Experiential learning	Shared learning among professionals –Appropriate referrals

Table 4

Service organisation-level programme theory model.

CHARACTERISTIC OF PROGRAMME

CONTEXT

MECHANISM

OUTCOME

Service Collaboration

Health system characteristics:

– Siloed health system
– Resistant to cross-service collaboration
– Lack of clarity about sharing consumer information

Systemic barriers:

– Socio-economic determinants of health
– historical perceptions of health services
– Poor health literacy
– Geographical isolation from services

Programme characteristics:

– Complexity of the HHAN initiative makes it challenging to explain to other services

Consumer characteristics:

– Vulnerability

– Shared vision at the agency level buy-in and shared responsibility
– Shared outcome framework – buy-in and shared responsibility
– Information sharing protocols – perceived cooperation and trust
– Resources shared – perceived cooperation and encouragement
– Training opportunities shared – perceived cooperation and encouragement

– Breakdown of silos
– Collaboration between services
– Recognition by service partners
– Utilising appropriate services
– Acknowledgement and acceptance of HHAN
– Foundations for integration

Service provider-level programme theory model.

Service organisation-level programme theory model.

Overarching mechanisms present at all levels of the HHAN logic model.

CIMO:	Context-Intervention-Mechanism-Outcome
SLHD:	Sydney Local Health District
HHAN:	Healthy Homes and Neighbourhoods
ToC:	Theory of Change

Formulating Initial Programme Theories of the Healthy Homes and Neighbourhoods Integrated Care Initiative

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Paradigm

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