Intersectoral Cooperation in 12 European Case Studies Aiming for Better Health, Environmental Sustainability, and Health Equity: Protocol for a Qualitative Evaluation

Abstract

Background The INHERIT (INtersectoral Health and Environment Research for InnovaTion) project has evaluated intersectoral cooperation (IC) in 12 European case studies attempting to promote health, environmental sustainability, and equity through behavior and lifestyle changes. These factors are the concerns of multiple sectors of government and society. Cooperation of health and environmental sectors with other sectors is needed to enable effective action. IC is thus essential to promote a triple win of health, sustainability, and equity. Objective This paper describes the design of a qualitative study to gain insights into successful organization of IC, facilitators and barriers, and how future steps can be taken to improve IC in the evaluated case studies. Methods Each case study was assessed qualitatively through a focus group. A total of 12 focus groups in 10 different European countries with stakeholders, implementers, policymakers, and/or citizens were held between October 2018 and March 2019. Five to eight participants attended each focus group. The focus group method was based on appreciative inquiry, which is an asset-based approach focusing on what works well, why it is working well, and how to strengthen assets in the future. A stepped approach was used, with central coordination and analysis, and local implementation and reporting. Local teams were trained to apply a common protocol using a webinar and handbook on organizing, conducting, and reporting focus groups. Data were gathered in each country in the local language. Translated data were analyzed centrally using deductive thematic analysis, with consideration of further emerging themes. Analyses involved the capability, opportunity, motivation-behavior (COM-b) system to categorize facilitators and barriers into capability, motivation, or opportunity-related themes, as these factors influence the behaviors of individuals and groups. Web-based review sessions with representatives from all local research teams were held to check data analysis results and evaluate the stepped approach. Results Data collection has been completed. A total of 76 individuals participated in 12 focus groups. In December 2019, data analysis was nearly complete, and the results are expected to be published in fall 2020. Conclusions This study proposes a stepped approach that allows cross-country focus group research using a strict protocol while dealing with language and cultural differences. The study generates insights into IC processes and facilitators in different countries and case studies to filter out which facilitators are essential to include. Simultaneously, the approach can strengthen cooperation among stakeholders by looking at future cooperation possibilities. By providing knowledge on how to plan for, improve, and sustain IC successfully to deal with today’s multisectoral challenges, this study can contribute to better intersectoral action for the triple win of better health, sustainability, and equity. This protocol can serve as a tool for other researchers who plan to conduct cross-country qualitative research. International Registered Report Identifier (IRRID) RR1-10.2196/17323

Facilitators and barriers of intersectoral co-operation to promote healthier and more environmentally friendly behaviour: a qualitative evaluation through focus groups for the INHERIT project

“…To study IC, we conducted twelve focus groups from October 2018 to March 2019. The focus group methodology is described in detail in a protocol paper [ 26 ] and will only be briefly explained in this paper.…”

“…Focus groups took place in ten different European countries. See Table 1 for the name, country and description of each case study [ 26 ]. Each focus group consisted of five to eight participants who were or had been involved in the co-operation process of that specific case study (average of six participants, with a total of 76 participants).…”

“…This study followed a stepped design with central coordination and data analysis and local implementation and reporting (see Fig. 1 for an overview of the study procedures and roles) [ 26 ]. This prevented language and cultural barriers that could have posed an issue because the case studies were taking place in different countries.…”

“…One lead research team (NvdV, LdB, BS, HK) coordinated the data collection that was carried out by local research teams in the different European countries. A webinar and a handbook were developed including reporting forms and checklists to guide local research teams through the implementation process of each focus group [ 26 ]. This included information on core principles of the focus groups and on planning, conducting, note taking and reporting to the lead research team.…”

Encouraging and Enabling Lifestyles and Behaviours to Simultaneously Promote Environmental Sustainability, Health and Equity: Key Policy Messages from INHERIT

“…The interventions were implemented and/or studies conducted over different timescales, over a year’s time. Twelve of the case studies were evaluated qualitatively through a process involving focus groups deploying an “appreciative inquiry” methodology, to explore success factors as well as barriers to inter-sectoral cooperation and implementation [ 72 ]. Nine of the studies underwent quantitative evaluations into their impact on attitudes/intentions and behaviours related to health and the environment, using a limited set of validated tools to examine healthy eating, physical activity, mental wellbeing, and use of green space, as relevant to particular pilots.…”