Open AccessRefining Program Theory for a Place-Based Integrated Care Initiative in Sydney, Australia
Author(s) -
John Eastwood,
Salwa Barmaky,
Sally Hansen,
Erin Millere,
Suzanne Ratcliff,
Penelope Fotheringham,
Heidi Coupland,
Denise de Souza
Publication year - 2020
Publication title -
international journal of integrated care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.083
H-Index - 32
ISSN - 1568-4156
DOI - 10.5334/ijic.5422
Subject(s) - empowerment , context (archaeology) , integrated care , theory of change , nursing , service (business) , grounded theory , qualitative research , medicine , business , public relations , health care , sociology , marketing , political science , paleontology , social science , anthropology , law , biology
Introduction: The Healthy Homes and Neighbourhoods (HHAN) Integrated Care Program seeks to enhance vulnerable family engagement with health and social services through a care coordination model. Besides servicing families in Sydney, HHAN has also established place-based initiatives (PBIs) in areas of disadvantage such as Redfern. The Redfern PBI co-locates HHAN with housing, drug and alcohol services, and financial and legal services. This integration aims to facilitate service access and multi-agency support for vulnerable families in Redfern. Hence, this study aims to evaluate for whom, when and why HHAN’s PBI at Redfern works, or not, and what are its outcomes. Methods: The project utilises critical realist methodology to undertake a qualitative evaluation of the impact of the PBI on clients, services and the community. Purposive sampling was used to identify 21 participants including HHAN clients, HHAN staff and stakeholders (HHAN partners). In-depth, semi-structured interviews were audio-recorded, transcribed, coded and analysed using a context (C), intervention (I), mechanism (M) outcome (O) (CIMO) approach to abductive analysis. Results: Five key CIMO configurations of the Redfern PBI emerged – whole-of-family involvement, flexibility, trust, building connections and co-location. Whilst each theory had specific outcomes, overall client outcomes included improved access to services, better outlook, empowerment and engagement with services. Service outcomes included increased collaboration and foundation for integration between HHAN and other services. Negative outcomes included lack of full integration, the risk associated with integration and difficulty evaluating impact. Conclusion: This study successfully refined the program theory for subsequent use in later implementation of critical realist evaluation studies.