Department of Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain.
OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain.
Int J Environ Res Public Health. 2020 Apr 24;17(8):2959. doi: 10.3390/ijerph17082959.
Health impact assessment (HIA) has scarcely been developed in Spain, in comparison with other European countries. Moreover, little is known about the effectiveness of HIA, taking into account direct impacts-changes on the decision-making process-as well as indirect impacts or those related to the process outcomes. From this broad perspective of HIA usefulness, the purpose was to assess the effectiveness of five HIAs carried out in Spain at the local level, and the role played by context and process factors on these impacts.
We carried out a qualitative study based on 14 interviews to HIAs participants from different sectors. A documentary review and nonparticipant observation techniques were implemented for an in depth understanding.
The direct effectiveness of the HIAs was partial, but they had indirect effectiveness in all cases. The institutional and socio-political context, however, was not favorable to effectiveness. The elements of the process were largely determined by the context, although their influence, mediated by the role of proactive individuals, favored the effectiveness of the HIAs.
When assessing HIA effectiveness, it is important to take into account a broad perspective on the nature of impacts and those factors influencing direct and indirect effectiveness. In Spain, the institutional and sociopolitical context was less favorable to HIA effectiveness than process-related factors. In order to implement the Health in All Policies strategy, will be necessary to improve context-related factors, such as institutional facilitators for HIA and democratic quality.
与其他欧洲国家相比，健康影响评估（HIA）在西班牙的发展甚少。此外，考虑到直接影响（决策过程的变化）以及间接影响或与过程结果相关的影响，HIA 的有效性知之甚少。从 HIA 有用性的这个广泛角度来看，目的是评估在地方一级进行的五项 HIA 的有效性，以及背景和过程因素对这些影响的作用。
我们进行了一项基于对来自不同领域的 HIA 参与者的 14 次访谈的定性研究。为了深入了解情况，我们采用了文献回顾和非参与观察技术。
HIA 的直接效果是局部的，但在所有情况下都具有间接效果。然而，制度和社会政治背景不利于有效性。尽管通过积极主动的个人的作用来介导，但过程要素在很大程度上取决于背景，有利于 HIA 的有效性。
在评估 HIA 的有效性时，重要的是要考虑到影响的性质和影响直接和间接有效性的因素的广泛观点。在西班牙，制度和社会政治背景不如与过程相关的因素有利于 HIA 的有效性。为了实施“所有政策皆健康”战略，有必要改善与制度相关的因素，例如 HIA 的机构促进因素和民主质量。
