Introduction
Funded by a Public Health Ontario ‘Locally Driven Collaborative Project’
grant, a team led by public health practitioners set out to develop and test a comprehensive
set of indicators to guide health equity work in local public health agencies (LPHAs).
Methods
The project began with a scoping review, consultation with content experts,
and development of a face-validated set of indicators aligned with the four public health
roles to address health inequities (NCCDH, 2014), plus a fifth set of indicators related to
an organizational and system development role. We report here on the field testing of
the indicators for feasibility, face validity (clarity, relevance), reliability, and comparability
in four Ontario LPHAs. Data were collected by two separate individuals or groups
at each site, during two consecutive periods. These individuals participated in separate
focus groups at the end of each test period, which further examined indicator clarity,
data source availability and relevance. A third focus group explored anticipated indicator
uses.
Results
Field testing showed that indicators addressed important issues in all public
health roles. Although the capacity for indicator use varied, all test sites found the indicators
useful. Suggestions for improved clarity were used to refine the final set of indicators,
and to develop a Health Equity Indicator User Guide with background information
and recommended resources.
Conclusion
The process of evaluating health equity-related activity within LPHAs is
still in its early stages. This project provides Ontario LPHAs with a tool to guide health
equity work that may be adaptable to other Canadian jurisdictions.
Implementation of the Health Equity Impact Assessment (HEIA) tool in a local public health setting: challenges, facilitators, and impacts
