Determinants of organisational change to increase health equity through sport

In Australia a number of population sub-groups are underrepresented in organised physical activity, and therefore not able to gain from the physical, mental and social health benefits that this offers. Sport organisations have the potential to contribute to the health and wellbeing of a more diverse segment of the population than previously as partners in health promotion efforts to increase health equity. In 2007-11 the Victorian Health Promotion Foundation implemented the Participation in Community Sport and Active Recreation (PICSAR) program that involved funding 61 projects aimed at engaging Indigenous Australians, people with disabilities, low socio-economic groups and new arrivals to Australia in organised physical activity. The study aimed to identify the conditions and actions that were necessary for successfully re-orienting sporting organisations towards health equity. It examined: the most important variables that influence change in participating organisations; the actions that change agents took to influence practice and policy; and how capacity building initiatives influenced the organisational changes that were undertaken.
 
   A mixed methods study was conducted in 10 purposively sampled State Sporting Associations (SSAs) funded under the PICSAR program using an Applied Policy Research approach. Semi-structured interviews were conducted with SSA Project Managers, Middle and Senior Managers, and partner agency representatives involved in the implementation of the PICSAR program (n= 141 informants). In addition, an organisational change assessment survey was administered immediately after interviews with SSA staff (n=58). These qualitative and quantitative data were collected annually over three years of the program. Interviews with informants from SSAs were transcribed and analysed using a thematic data analysis method. Non-parametric statistical methods were used to analyse the survey data. Qualitative data were used to interpret quantitative data and vice versa.
 
   This study found that substantial practice change, moderate strategic change, minimal cultural change (mainly confined to groups directly involved in implementation), and organisational learning was influenced by: belief in the need for change; leadership support for change; the existence of dedicated resources for change; strategic and ideological alignment between the SSA and the PICSAR program’s values and objectives; and effective external partnerships. The findings of this study suggest that organisational change towards increasing health equity through sport is achieved by changing practice first, then lessons through practice influence organisational strategy and structure, and through repetition of practice it is expected that cultural change in support of the new strategic and operational environment will occur. These findings are interpreted using pertinent insights from Lewin’s theories of organisational change, diffusion of innovations theory, organisational learning theories, and theories of organisational culture and receptive contexts for change.

   Policy makers should have modest expectations regarding the institutionalisation of health equity and other related values in sporting organisations during the life of programs with defined timeframes. A new model named the Strategic Organisational Change for Health Promotion model is proposed for health promotion practitioners and policy makers, identifying how organisational change can be achieved without an immediate congruence between the ideologies of the change initiative and the culture of the recipient organisations.