title: The effectiveness of health impact assessment in influencing decision-making in Australia and New Zealand 2005-2009.
abstract: BACKGROUND
  Health Impact Assessment (HIA) involves assessing how proposals may alter the determinants of health prior to implementation and recommends changes to enhance positive and mitigate negative impacts. HIAs growing use needs to be supported by a strong evidence base, both to validate the value of its application and to make its application more robust. We have carried out the first systematic empirical study of the influence of HIA on decision-making and implementation of proposals in Australia and New Zealand. This paper focuses on identifying whether and how HIAs changed decision-making and implementation and impacts that participants report following involvement in HIAs.
  
  
  METHODS
  We used a two-step process first surveying 55 HIAs followed by 11 in-depth case studies. Data gathering methods included questionnaires with follow-up interview, semi-structured interviews and document collation. We carried out deductive and inductive qualitative content analyses of interview transcripts and documents as well as simple descriptive statistics.
  
  
  RESULTS
  We found that most HIAs are effective in some way. HIAs are often directly effective in changing, influencing, broadening areas considered and in some cases having immediate impact on decisions. Even when HIAs are reported to have no direct effect on a decision they are often still effective in influencing decision-making processes and the stakeholders involved in them. HIA participants identify changes in relationships, improved understanding of the determinants of health and positive working relationships as major and sustainable impacts of their involvement.
  
  
  CONCLUSIONS
  This study clearly demonstrates direct and indirect effectiveness of HIA influencing decision making in Australia and New Zealand. We recommend that public health leaders and policy makers should be confident in promoting the use of HIA and investing in building capacity to undertake high quality HIAs. New findings about the value HIA stakeholders put on indirect impacts such as learning and relationship building suggest HIA has a role both as a technical tool that makes predictions of potential impacts of a policy, program or project and as a mechanism for developing relationships with and influencing other sectors. Accordingly when evaluating the effectiveness of HIAs we need to look beyond the direct impacts on decisions.
authors.forename: Fiona
authors.initials: F
authors.lastname: Haigh
authors.forename: Fran
authors.initials: F
authors.lastname: Baum
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Dannenberg
authors.forename: Mark F
authors.initials: MF
authors.lastname: Harris
authors.forename: Ben
authors.initials: B
authors.lastname: Harris-Roxas
authors.forename: Helen
authors.initials: H
authors.lastname: Keleher
authors.forename: Lynn
authors.initials: L
authors.lastname: Kemp
authors.forename: Richard
authors.initials: R
authors.lastname: Morgan
authors.forename: Harrison N G
authors.initials: HN
authors.lastname: Chok
authors.forename: Jeff
authors.initials: J
authors.lastname: Spickett
authors.affiliation: Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia. e.harris@unsw.edu.au.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Harris
mesh_terms: D001315:Australia / Q000453:epidemiology; D003659:Decision Making, Organizational; D062489:Health Impact Assessment / Q000379:methods* / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007407:Interviews as Topic; D009520:New Zealand / Q000453:epidemiology; D011050:Policy Making; D015397:Program Evaluation; D011795:Surveys and Questionnaires