Canadian Inuit have been undergoing rapid lifestyles transition in the last five decades [
According to the World Health Organization [
Despite the increasing rates of obesity in Nunavut Inuit population and the attendant physical, psychosocial, and economic impacts, the extent to which Nunavut Department of Health (NDH) is committed to implementing change efforts is not known. This has not been previously examined. Evidence from past literatures suggests that relatively little is known about factors influencing implementation of change efforts within healthcare organizations [
According to Stokols [
In the current study, we examined the commitment of NDH as an upstream macroenvironmental factor influencing the implementation of effective and appropriate obesity prevention policies and programs in the Canadian Arctic. This government department is mandated to formulate health policies and standards, including implementing initiatives such as obesity prevention programs and services. This study therefore examined the collective organizational readiness of the NDH to implement obesity prevention policies and programs in the territory. To date, research on the topic has largely focused on individual readiness and less on collective readiness at organizational level [
To explore NDH’s commitment to implementing obesity prevention policies and programs in view of the rate in the territory, we utilized a validated instrument called Organizational Readiness for Implementing Change (ORIC), developed by Shea et al. [
The measure of organizational readiness is a psychometric instrument that is underpinned by Weiner’s theory of organization readiness for change [
Research model explaining the relationships between NDH’s readiness (change commitment) and the determining factors.
Nunavut is located in the Arctic Region of Canada. The territory covers an extensive area of 2,093,190 km2, accounting for 21% of Canada’s land and freshwater area [
The Government of Nunavut Department of Health is responsible for delivering healthcare services in the territory, including developing policies and legislations that govern the healthcare system and programs for prevention of illnesses and elimination or reduction of risk factors of diseases including obesity.
Ethical approval was obtained from the Ethical Review Committee of Psychology and Neuroscience at Maastricht University, Netherlands (Reference# ECP-148 05_03_2015) as well as through a research license from the Nunavut Research Institute (License# 050 1315-Amended). An initial pilot was conducted with a random sample of 10 volunteers who were program officers and policy analysts in the Department of Health. The purpose of the study was discussed with the volunteers who later reviewed the research questions, completed the questionnaires, and provided comments. In response to the feedback, we provided definitions of terms used in the facets of change commitment being explored: valence or perceived value (intrinsic attractiveness of the change efforts and to what extent the change valued is); efficacy (shared belief in the employees’ collective ability to engage in a course of action that will lead to change); resource availability (collective perception by employees that resources needed to implement are available, including fund, personnel, equipment, and infrastructure); and knowledge (perceived knowledge about resources, time, and tasks requirements for implementing the desired change). Further, we provided examples of healthy public policies and both conventional and innovative approaches that have either been adopted by regional and national governments or proposed by obesity prevention experts: increasing taxes on junk foods and subsidies on healthy foods [
The ORIC questionnaire was distributed to all public/population health and health policy personnel who were responsible for policy or program development, implementation, and evaluation in the Department of Health. Of the 93 questionnaires that were distributed only 67 were returned and fully completed across relevant divisions within the NDH.
Following collection, data were entered in IBM SPSS Statistics Version 24 for cleaning and subsequent analyses. Data were analyzed using descriptive statistics, Pearson’s correlations, and multivariate linear regressions. Missing values were imputed by the item means. Scores for the study variables were checked for normal distributions using tests for skewness and kurtosis [
Internal consistency analyses of the constructs of organizational readiness revealed good psychometric properties according to their Cronbach alpha (
67 questionnaires were fully completed for analysis, representing 72% of the public health workforce. Of these, 82% were women and 18% were men, approximately reflecting gender distribution in the Department of Health’s workforce. Our findings showed that only 2.9% and 35.7% of respondents strongly agreed and agreed, respectively, with the statement that “we are committed to implementing obesity prevention policies and programs.” On the other hand, 28.6% of respondents disagreed or strongly disagreed with the statement. Another 28.6% of respondents neither agreed nor disagreed that NDH was committed to implementing obesity prevention policies and programs.
Relationships between the variables were examined (Table
Mean scores, standard deviations, and bivariate Pearson correlations for study variables (n=67).
Variables | Mean (SD) | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
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1. Commitment | 15.15 (4.16) | 1 | | |||||
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2. Perceived value | 41.28 (5.39) | | 1 | | ||||
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3. Efficacy | 21.87 (4.39) | | | | | |||
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4. Resource availability | 16.26 (2.62) | | | | 1 | |||
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5. Knowledge-time | 2.42 (.78) | | | | | | ||
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6. Knowledge-resources | 4.03 (.65) | | | | | | | |
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7. Knowledge-actions | 3.61 (.82) | | | | | | | 1 |
In the multivariate linear regression model, perceived value and the knowledge-time were strongly correlated (Table
Standardised regression coefficients,
Predictor variable | | | R2 |
---|---|---|---|
Perceived value | .66 | <.001 | .60 |
Efficacy | .11 | .40 | |
Resource Availability | -.06 | .58 | |
Knowledge-time | .18 | .04 | |
Knowledge-resources | .11 | .19 | |
Knowledge-actions | .06 | .54 |
The study examined the degree of NDH’s commitment to the implementation of effective and appropriate obesity prevention policies and programs. Results showed that organization-level commitment to implementing obesity prevention policies and programs was generally low. Research evidence in the field has suggested that a lack of organizational readiness for change may account for as many as half of all unsuccessful change initiatives in a variety of fields including healthcare. This often necessitates a redesign of intervention efforts [
Our results indicated that only 2.9% of the employees were very confident of their organization’s commitment to implementing obesity prevention policies and programs, and approximately one-third of the employees were somewhat confident. Our findings demonstrated that perceived value, efficacy, and resource availability were positively associated with NDH’s commitment to implementing obesity prevention policies and programs in Nunavut. This is in line with Weiner’s theory of organizational readiness for change which postulates that change commitment and perceived capacity for desired change (change efficacy) combine to determine organizational readiness [
The large number of individuals surveyed relative to the numerical strength of the employees in the lines of work, the high response rate, and the gathering of independent responses from employees in the lower and management cadres within NDH can all be considered as strengths of the study. Our research provides preliminary empirical confirmation of Weiner’s framework of organizational readiness. The findings also provide a strong basis for a more extensive investigation given the importance and relevance of organizational readiness to a successful and sustainable implementation of changed efforts in healthcare organizations. In the context of NDH, it is important for the organization to critically examine the underlying factors mediating the abysmally low organizational commitment to implementing obesity prevention policies and programs.
The responses obtained from the NDH employees showed low efficacy and perceived value, suggesting that the collective capability to engage in a course of action that will lead to change is suboptimal. The perceived collective value of the implementation efforts appears to be lower than what is needed to move changed efforts in a positive direction. The low perceived value on obesity prevention efforts may be linked to a more focused attention on other pressing social/health issues that were prioritized locally during the community-based needs assessment and priority setting exercises in the face of limited resources. Findings from the needs assessment (unpublished) indicated that while obesity was not identified as a priority, food insecurity, alcohol abuse, and tobacco smoking were ranked as top three priorities in many communities and are currently receiving considerable attention from NDH. The limited community-level support may have combined with other factors including financial limitations to trigger suboptimal efforts on obesity prevention.
Our results call for the redesign of intervention efforts that focus on eliminating barriers and promoting facilitators of changed efforts. For example, collective perception by employees that resources needed to implement required policies and programs as well as other situational factors must be fully analyzed and appropriate elements incorporated in the redesign of an intervention strategy.
Organizational readiness is a team rather than individual effort. Lehman et al. [
Canadian Arctic has undergone significant social and environmental changes resulting in the disruption of Nunavut Inuit traditional ways of life. The changes have reduced the reliance on traditional food gathering and processing activities and increased dependence on energy-dense store-bought foods and motorized transportation. As a consequence, many Nunavut Inuit have become overweight or obese and developed diet-sensitive chronic diseases. Although these sociocultural and environmental changes cannot be reversed or stopped, opportunities exist to explore policy and program interventions for the population. Despite the severity of the problem and the urgent need to identify effective solutions, findings from the current study suggest that the collective capacity within the NDH to effectively respond by developing and implementing interventions is low. Efforts should therefore focus on how employees’ perceived value and efficacy can be improved to translate implementation efforts into tangible health and psychosocial outcomes.
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Ethical approval was obtained from the Ethical Review Committee of Psychology and Neuroscience at Maastricht University, Netherlands (Reference# ECP-148 05_03_2015) as well as through a research license from the Nunavut Research Institute (License# 050 1315-Amended).
We acknowledge that the findings reported in this manuscript were presented at the 25th European Congress on Obesity, Vienna, Austria, May
The authors declare that they have no conflicts of interest to declare regarding this publication.
Victor O. Akande and Stef P. J. Kremers conceptualized the study. Victor O. Akande collected the data, conducted the statistical analyses, and drafted the manuscript. All authors reviewed draft versions of the manuscript and provided critical feedback. All authors have made a significant contribution to this manuscript, and all authors read and approved the final manuscript.
No funding was received for the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.