Priority Setting and Policy Advocacy for Community Environmental Health: A Comparative Case Study of Three Canadian Nursing Associations

Abstract

This thesis examined factors that influence three Canadian Nursing Associations’ priority setting and policy advocacy for community environmental health (CEH). The research questions that guided the study were: (a) how do the nature and scope of nursing organizations’ engagement for CEH policies differ according to provincial and federal contexts? and (b) how do nursing organizational factors and external system factors influence the priority-setting and policy advocacy choices for CEH policy? To answer these questions I undertook a qualitative comparative case study. The research was guided by epistemological and methodological principles of interpretative description and informed by whole-systems socio-ecological theory and institutional theory. Data were collected through participant interviews (n=41) and document review. Guided by framework analysis and the use of descriptive and conceptually-oriented matrices, cases were analyzed using an iterative and inductive approach to identify case patterns. These case patterns were then compared to identify cross-cutting factors that influence the Nursing Associations’ priority setting and policy advocacy for CEH. Key findings are represented in an integrated conceptual framework. Nursing Associations’ priority setting and policy advocacy are embedded in a dynamic policy field whereby structures and institutional pressure both create opportunities and narrow the Nursing Associations’ options for engaged CEH advocacy. The findings lead to recommendations for practice, policy, and research that have relevance for the profession, nursing associations, and policy decision-makers.