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BMC Health Serv Res. 2017 Dec 1;17(1):796. doi: 10.1186/s12913-017-2730-1.

What systemic factors contribute to collaboration between primary care and public health sectors? An interpretive descriptive study.

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School of Nursing, University of British Columbia, 2211 Wesbrook Mall, T161, Vancouver, Canada.
Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, Canada.
School of Nursing, University of Victoria, HSD B220, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
Dalhousie University, Room G26, Forrest Bldg., 5869 University Avenue, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
School of Nursing Health Sciences Center Room 3N25E, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.



Purposefully building stronger collaborations between primary care (PC) and public health (PH) is one approach to strengthening primary health care. The purpose of this paper is to report: 1) what systemic factors influence collaborations between PC and PH; and 2) how systemic factors interact and could influence collaboration.


This interpretive descriptive study used purposive and snowball sampling to recruit and conduct interviews with PC and PH key informants in British Columbia (n = 20), Ontario (n = 19), and Nova Scotia (n = 21), Canada. Other participants (n = 14) were knowledgeable about collaborations and were located in various Canadian provinces or working at a national level. Data were organized into codes and thematic analysis was completed using NVivo. The frequency of "sources" (individual transcripts), "references" (quotes), and matrix queries were used to identify potential relationships between factors.


We conducted a total of 70 in-depth interviews with 74 participants working in either PC (n = 33) or PH (n = 32), both PC and PH (n = 7), or neither sector (n = 2). Participant roles included direct service providers (n = 17), senior program managers (n = 14), executive officers (n = 11), and middle managers (n = 10). Seven systemic factors for collaboration were identified: 1) health service structures that promote collaboration; 2) funding models and financial incentives supporting collaboration; 3) governmental and regulatory policies and mandates for collaboration; 4) power relations; 5) harmonized information and communication infrastructure; 6) targeted professional education; and 7) formal systems leaders as collaborative champions.


Most themes were discussed with equal frequency between PC and PH. An assessment of the system level context (i.e., provincial and regional organization and funding of PC and PH, history of government in successful implementation of health care reform, etc) along with these seven system level factors could assist other jurisdictions in moving towards increased PC and PH collaboration. There was some variation in the importance of the themes across provinces. British Columbia participants more frequently discussed system structures that could promote collaboration, power relations, harmonized information and communication structures, formal systems leaders as collaboration champions and targeted professional education. Ontario participants most frequently discussed governmental and regulatory policies and mandates for collaboration.


Canada; Health services delivery; Health system; Primary health care; Qualitative

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