Table 2 Data sources in relation to conceptual elements of theoretical framework
Conceptual elements of the institutional theory underpinning data analysis and synthesis | Strength of evidence from different data sources | Key finding from the data sources | ||
|---|---|---|---|---|
Document review | Online survey | Interviews | ||
Regulatory context (policies, rule settings and contractual obligations) impacting on the structure and activities of MLs around population health planning | ✓✓✓ | ✓ | ✓✓ | - Centralised control of programs, funding and priorities, the lack of autonomy and flexibility, short timeframes, and little recognition of health promotion and social determinants. These factors limited MLs’ capacity for population health planning and were strongly evident from the MLs guidelines and documents and confirmed in data from survey and interviews. A positive findings was the Federal policy emphasis on the inclusion of broader PHC professionals in MLs’ governance to incorporate the perspective of the wider PHC community beyond general practitioners. |
Normative context (organisational norms, values, feelings of social obligations in relation to population health planning | ✓ | ✓✓ | ✓✓✓ | - Mixed views on social determinants of health: there were efforts by some MLs to implement strategies e.g. collaboration with state government and community organisations, using flexible funding and establishment of inclusive governance to overcome regulatory barriers to doing health promotion and social determinants of health. Examples of alignment between regulatory and normative forces e.g. partnership with the state departments of health as an enabling factor for population health planning. |
Cultural-cognitive context (common beliefs and logics of action taken for granted e.g. social model versus medical approach) | ✓✓ | ✓✓ | ✓✓✓ | - Biomedical, service delivery approach most evident and very little attention to broader determinants. This approach was promoted by Federal government policy and guidelines and confirmed through survey and interview data |
Key actors the their ability to pursue decisions in population health planning | ✓✓ | ✓✓✓ | ✓✓✓ | - State department of health, public and private health providers and professionals were reported as key actors in MLs’ planning process. Community involvement limited to consultation and information sharing. Little evidence of the involvement of actors outside health (including local government and social sectors) in population health planning. Although documentary sources included a range of organisations that MLs worked with, the survey and interview data revealed their limited contribution to decision making and PHC planning. |
Ideas (values around PHC among PHC stakeholders) | ✓ | ✓ | ✓✓✓ | Conflicting ideas on concepts associated with population health, health equity, health promotion and addressing social determinants of health, as collected from different sources particularly interviews assisted to provide information about existing values around PHC and it variation among stakeholders. |