title: Moving towards a new vision: implementation of a public health policy intervention.
abstract: Public health systems in Canada have undergone significant policy renewal over the last decade in response to threats to the public's health, such as severe acute respiratory syndrome. There is limited research on how public health policies have been implemented or what has influenced their implementation. This paper explores policy implementation in two exemplar public health programs -chronic disease prevention and sexually-transmitted infection prevention - in Ontario, Canada. It examines public health service providers', managers' and senior managements' perspectives on the process of implementation of the Ontario Public Health Standards 2008 and factors influencing implementation.
  
  
  
  Public health staff from six health units representing rural, remote, large and small urban settings were included. We conducted 21 focus groups and 18 interviews between 2010 (manager and staff focus groups) and 2011 (senior management interviews) involving 133 participants. Research assistants coded transcripts and researchers reviewed these; the research team discussed and resolved discrepancies. To facilitate a breadth of perspectives, several team members helped interpret the findings. An integrated knowledge translation approach was used, reflected by the inclusion of academics as well as decision-makers on the team and as co-authors.
  
  
  
  Front line service providers often were unaware of the new policies but managers and senior management incorporated them in operational and program planning. Some participants were involved in policy development or provided feedback prior to their launch. Implementation was influenced by many factors that aligned with Greenhalgh and colleagues' empirically-based Diffusion of Innovations in Service Organizations Framework. Factors and related components that were most clearly linked to the OPHS policy implementation were: attributes of the innovation itself; adoption by individuals; diffusion and dissemination; the outer context - interorganizational networks and collaboration; the inner setting - implementation processes and routinization; and, linkage at the design and implementation stage.
  
  
  
  Multiple factors influenced public health policy implementation. Results provide empirical support for components of Greenhalgh et al's framework and suggest two additional components - the role of external organizational collaborations and partnerships as well as planning processes in influencing implementation. These are important to consider by government and public health organizations when promoting new or revised public health policies as they evolve over time. A successful policy implementation process in Ontario has helped to move public health towards the new vision.
authors.affiliation: Faculty of Health Sciences, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, L9S 4K1, ON, Canada. valaitis@mcmaster.ca.
authors.forename: Ruta
authors.initials: R
authors.lastname: Valaitis
authors.affiliation: School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
authors.forename: Marjorie
authors.initials: M
authors.lastname: MacDonald
authors.affiliation: School of Health Studies, University of Western Ontario, Arthur & Sonia Labatt Health Sciences Building Room 222, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Kothari
authors.affiliation: Faculty of Health Sciences, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, L9S 4K1, ON, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: O'Mara
authors.affiliation: School of Health Studies, University of Western Ontario, Arthur & Sonia Labatt Health Sciences Building Room 403, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Regan
authors.affiliation: School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, BC Matthews Hall, Room 2310, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Garcia
authors.affiliation: Faculty of Health Sciences, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, L9S 4K1, ON, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Murray
authors.affiliation: Public Health Ontario, 480 University Avenue, Suite 300, Toronto, M5G1V2, ON, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Manson
authors.affiliation: (Formerly with the) Public Health Standards, Practice and Accountability Branch, Population and Public Health Division, Ontario Ministry of Health and Long-Term Care, 393 University Ave. Suite 2100, Toronto, ON, M7A 2S1, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Peroff-Johnston
authors.affiliation: Region of Peel, 10 Peel Centre Drive, Brampton, L6T 4B9, ON, Canada.
authors.forename: Gayle
authors.initials: G
authors.lastname: Bursey
authors.affiliation: School of Health Studies, University of Western Ontario, Arthur & Sonia Labatt Health Sciences Building Room 403, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Boyko
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control; D003299:Cooperative Behavior; D006291:Health Policy; D006801:Humans; D033181:Information Dissemination; D007407:Interviews as Topic; D009864:Ontario; D011050:Policy Making; D016730:Program Development; D011634:Public Health; D011640:Public Policy; D012111:Residence Characteristics; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D057170:Translational Research, Biomedical
keywords: Health policy; Implementation; Implementation science; Knowledge translation; Policy; Public health