Factors that influence evidence-informed meso-level regional primary health care planning: a qualitative examination and conceptual framework

Abstract Background: While evidence-based clinical practice, and evidence-informed health policy-making have received much research attention, little is known about evidence-informed primary health care (PHC) planning in decentralised, meso-level regional organisations. In this paper we examine the factors that influence planning within this environment, and present a conceptual framework. Methods: We employed a mixed methods approach: case studies of five Australian Primary Health Networks (PHNs), involving 29 primary interviews and secondary analysis of 38 prior interviews; and analysis of planning documents from all 31 PHNs. The analysis was informed by a WHO framework of evidence-informed policy-making, and institutional theory. Results: We identified a broad range of actors and factors that influence evidence-informed PHC planning, at different levels of context: organisational/internal, regional, and national. The additional regional layer of context adds to the complexity of planning. Some distal factors influence more proximal factors, as well as directly influencing PHC planning, and some factors span the levels of context, but may be conflicting, such as ideology and values. Conclusions: This research has identified a wide range of factors that influence evidence-informed meso-level PHC planning, acting at various levels of context. Like national health policy-making, meso-level PHC planning occurs in a complex environment, but with additional regional factors and influences. We have developed a conceptual framework of the meso-level PHC planning environment, which can be employed by similar regional organisations to elucidate influential factors and actors, and develop strategies and tools to promote transparent, evidence-informed PHC planning for better health outcomes.