Determinants of implementing heart health promotion activities in Ontario public health units: a social ecological perspective

This paper reports the results of a study undertaken to explain levels of i mplementation of heart health promotion activities observed in Ontario publ ic health agencies in 1997. Organizational-level data were collected by sur veying all 42 health departments in 1994, 1996 and 1997 as part of the Cana dian Heart Health Initiative Ontario Project. Guided by social ecological a nd organizational theories, the model examines relationships between implem entation and four sets of possible determinants of activity: (1) the predis position of agencies to undertake heart health promotion activities, (2) th eir capacity to undertake these activities, (3) internal organizational fac tors and (4) external system factors. A small set of five variables explain s almost half of the variance in implementation (R-2 = 0.46): organizationa l capacity (beta = 0.40), priority given to heart health (beta = 0.36), coo rdination of programs (beta = 0.19), use of resource centers (beta = 0.12) and participation in networks (beta = 0.09). The results suggest that model s integrating organizational and socio-ecological theories can help us unde rstand the implementation of community-based heart health promotion activit ies by public health agencies. Implications for future research, policy and practice are discussed.