Table 2 Wismar effectiveness categorisation with example quotes from questionnaire answers (N = 48)

Direct effectiveness 31 (65%)

General effectiveness 11 (23%)

A Community Education Project HIA “directly affected the way the project was implemented, and the recommendations to address equity issues were incorporated in the project plan… The HIA ensured that vulnerable groups were identified and that health messages and activities were adjusted to reach and include these groups where possible”.

“The HIA was a component in a continuous loop of evidence-based learning practice that we sought to build internally and value externally in order to change traditional practice.... Gathering the evidence base was a powerful tool giving communities and councillors and staff a common understanding of the issues that required attention and an avenue to do this”.

Opportunistic effectiveness 3 (6%)

No effectiveness 3 (6%)

“I’m going to have to be honest here. … I still think it helped us. The process helped us put some things in we thought should have happened. We knew that. This was just a way of tacking them into the places with”.

An HIA of a Health Promotion Plan was reported to have had no direct impact: “I think the HIA was buried. Since that time an ex-staff member on the team of decision-makers has told me that it was rejected because it made people accountable to their decisions!” However when asked whether they thought the decision would have been made without the HIA the same person responded negatively, saying that it “made people think about equity implications more - which was the purpose of the HIA”. They also felt the HIA had made a difference; it “Made it clear that the planning process was flawed and inequitable”.