Creación de capacidad para el abordaje intersectorial de la salud desde los gobiernos locales: Un estudio de intervención

Despite local governments are well positioned to modify the social determinants of health, there are multiple factors conditioning the implementation of approaches that integrate health perspective in all their sectors. Among those, sector’s lack of capacity for addressing health issues must be highlighted. Considering that, the study here presented has developed, implemented, and evaluated a capacity building intervention for intersectoral action for health at local governments. It was developed under a complex intervention perspective, which allowed to integrate systems thinking theory, and theories of the policy process and organizational change, identified as relevant for the design of the intervention. Also, a logic model was stablished to guide the process. Nineteen individuals representing various sectors within a local government participated in the study. It was conducted in the north of Spain; the programme was based on three 2-hour sessions and was evaluated in terms of efficacy, feasibility and acceptability, adopting a mixed method assessment. Quantitative results were evaluated using a pre-post design, by the CaPSalGOB questionnaire. This was designed and piloted ad hoc, and measured the capacity, in terms of knowledge, awareness, resources, skills and sectoral and government’s commitment. For qualitative results, semi-structured interviews were used, and they explored the perceived capacity after the intervention, feasibility and acceptability issues. The perceived capacity of the workers for addressing health issues from their respective sector increased. It was mainly related with the increase of their awareness (perceived and measured) in terms if the impact their sector had on the population’s health. The intervention was also effective for identifying resources for health addressing and the governmental commitment, but it was not statistically significant for the skills and sectoral commitment variables; neither for knowledge, which presented a really high score in the baseline data. In terms of feasibility, politicians’ absence in the study must be highlighted. All the participants were satisfied with the program, the facilitator and materials used. This study highlights the relevance of capacity building in these contexts and offers a starting point on which continue working. Furthermore, the integration of nursing in this field, and the role played during the intervention, has offered an example of how these professionals can have an influence on population’s health, fostering the government’s intersectoral action for health.