British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada; CIHR Canadian HIV Trials Network, 588-1081, Burrard Street, Vancouver, BC, V6B 3E6, Canada.
School of Social Work, York University, 4700, Keele Street, Toronto, ON, M3J 1P3, Canada.
Health Place. 2021 Nov;72:102696. doi: 10.1016/j.healthplace.2021.102696. Epub 2021 Nov 2.
The role of contextual factors for program implementation is well-documented; however, their changing function throughout implementation phases is less established. We conducted an institutional ethnography to understand how structural conditions for scaling up initiatives are shaped by public health policy. We conducted 25 interviews with implementers of a comprehensive sexual health testing service in Canada, 21 meeting observations, and textual analyses of key policies and reports. Our analysis revealed a disjuncture between implementers' task of scaling up programming and the actualities of working within the discursive and material confines of policies premised on HIV exceptionalism and underfunded integrated health services.
背景因素对于项目执行的作用已经得到充分证实；然而，它们在执行阶段不断变化的功能尚未得到充分确立。我们进行了一项制度民族志研究，以了解扩大倡议的结构性条件是如何受到公共卫生政策影响的。我们对加拿大一项全面性健康测试服务的实施者进行了 25 次访谈、21 次会议观察，并对关键政策和报告进行了文本分析。我们的分析揭示了实施者扩大计划任务与在基于 HIV 例外论和资金不足的综合卫生服务政策的话语和物质限制内工作的实际情况之间的脱节。
