Institute of Health Services and Policy Research (IHSPR)
Institute of Gender and Health (IGH)
Institute of Aboriginal Peoples' Health (IAPH)
Deadlines
Registration - August 31, 2001
Full proposals - October 12, 2001
Notification to successful applicants - January, 2002
Duration of projects: up to three years (can be shorter)
Available Funds
Maximum ANNUAL funding to be committed to this RFA: $300,000 from IHSPR + $300,000 from IGH, plus $100,000 from IAPH (contingent on project(s) with relevance to mandate of that Institute), plus any partner funding. Number of grants funded will depend on size of fundable grants, and on success of CIHR Institutes in securing other partners.
Introduction
The differences in health services available to residents of rural, remote and northern communities, on the one hand, and large urban centres on the other, are well known. But there are many other groups in our society who are 'marginalized' in the sense of having less immediate access to services that are appropriate for their circumstances, for any number of reasons. Examples include people with certain mental health problems or addictions, people with physical disabilities, Aboriginal peoples, injection drug users, women in certain circumstances, some ethnic minorities, the homeless, those with particular sexual orientations, and the poor. Members of these marginalized groups may either have limited access to appropriate health services or feel constrained in accessing services even if they are available.
Despite the fact that all Canadians enjoy financially unimpeded access to hospital and physician services irrespective of sex, geography, race, ethnicity, age, illness or disability, life circumstances, or income, in practice there are wide variations in the use of appropriate and effective services across all of these dimensions. The circumstances surrounding, and reasons for, the access problems will vary. In some cases access may be restricted for capacity reasons; in other situations, some populations may believe their access is restricted because of their (perceived or actual) marginalized status or because of the ways in which "illness", "disease" or "disability" are socially or culturally constructed. Furthermore some health services are not publicly funded. Geographic, financial, temporal, physical and social barriers to a wide range of health services have been reported. It is argued that improved access to health services would improve health and life circumstances and might also lower overall health and other public costs through delivering appropriate services to those who need them before more expensive and extensive intervention is required.
The purpose of this Request for Applications is to support cross-disciplinary research that will provide new evidence on the diverse factors that influence, and on approaches to improving, access to needed health services for vulnerable groups.
Backround
From January to May 2001, the three Institutes supporting this RFA were involved in extensive consultations intended to help shape their strategic plans and research priorities for the next five years. In the case of the Institute of Health Services and Policy Research, some of these consultations were undertaken in partnership with four other national organizations (the results of that partnered consultation process can be found in Listening for Direction: A national consultation on health services and policy issues on the IHSPR web site). The Institute of Gender and Health (IGH) conducted national brainstorming sessions involving over 160 people, and brainstorming sessions with special groups; issued an invitation on the IGH website; held meetings with centres of excellence, research chairs, policy influencers, community groups/organizations, individual researchers, research groups, other CIHR Institutes and potential partners; and, received written submissions from stakeholders.
The theme of this RFA, "Improving Access to Appropriate Health Services for Marginalized Groups", emerged as one of the top research priorities for each of the three Institutes. While the IHSPR, IGH and IAPH will be focusing on project funding for this theme area, the Canadian Health Services Research Foundation (CHSRF) will also be investing in this theme area by devoting $1.5M to fund a program of research through a complementary initiative focusing on the small, rural and remote communities aspect of the theme (refer to the last two items under Eligible Research Areas). This will be funded through CHSRF's open grants competition in September 2001.
This CIHR Request for Applications represents an invitation to develop innovative new approaches to addressing this important early priority.
Specific Objectives
The specific objectives of this Request are to support innovative projects that will help inform policy, program and management decisions relating to improved access to appropriate health services for identifiable "marginalized" groups. Preference will be given to studies with objectives that include the development of new approaches to identifying "marginalized populations", the negative impact on health or quality of life of differential access to particular types of appropriate services for these groups, and the articulation of the key barriers to access that result in such marginalization; the development, implementation, and evaluation of innovative approaches to reducing access impediments for such populations; the comparison/evaluation of alternative approaches already in place; or the evaluation of the effects of recent policy changes on access to appropriate health services for specific populations (including whether such policy changes have created new "marginalized populations"). Syntheses of existing evidence are not a priority, and will receive consideration only if they are likely to shed significant new light on related questions.
Projects may include the development or application of new methods/tools, particularly those from disciplines where health applications have not previously been common. Preference will be given to project applications that demonstrate the potential to bring such new approaches, measurement tools, methods, or disciplines to bear on the applied questions of interest (see below for examples), and that involve the active participation of investigators or partners representing the target audience(s)/ groups for the research.
Successful projects will demonstrate a clear strategy for "knowledge transfer" to relevant policy, program, and/or service decision-makers and to the public. Preference will also be given to projects involving research groups or collaborators from more than one institution or agency.
Eligible Research Areas
Examples of questions or topics that would fall within the ambit of this competition include (but are not restricted to):
What are the existing barriers to access to services for marginalized groups such as those with mental health problems or addictions; First Nations, Metis, Inuit or urban Aboriginal communities; women from visible minorities or with particular health conditions or life situations; groups with particular sexual orientation; incarcerated populations; the poor? What are the effects of these barriers on the health and quality of life of people in these groups?
Interventions/programs to identify marginalized groups and improve their access to appropriate services (e.g., comparative evaluative studies).
What interventions should target service providers and/or program planners, and what interventions should focus on consumers?
What models of primary health care can address the needs of and improve access for other marginalized populations?
What has the impact of recent health system reforms been on access to particular types of health services for particular groups (e.g. by gender, socio-economic status, ethnicity, education)? Have such reforms created new jurisdictional gaps in service coverage that differentially affect certain groups?
What factors influence the help-seeking approaches of marginalized groups?
In sectors of health care that are not publicly funded, how important are financial barriers in restricting access to appropriate services, and what are the impacts on health status, quality of life, and health and other social costs?
What effects has the transfer of jurisdiction, from federal government to First Nations and Inuit communities, for health services had on the health of or access to appropriate health care delivery in First Nations communities?
Empirical analysis of the impact and generalizability of international models for improving access to appropriate health care (e.g. primary health care, infectious disease prevention and management, chronic disease management, community-based primary prevention and early intervention) for indigenous peoples
What human resource, technology and transportation initiatives can improve access to specialty services for small, rural and remote communities? [The partnership with the CHSRF on this theme will involve the CHSRF issuing a call - as part of its open grants competition - in September 2001 inviting proposals for a program of research focusing on either this or the next question]
What models of primary health care can address the needs of and improve access for those living in small, rural, remote and isolated communities?
Mechanisms of Support
This RFA is designed to solicit project grant applications, with duration of up to three years, potentially renewable only if the theme is one of the priorities being funded in the year of renewal. As noted above, the CHSRF will be supporting a program of research focusing on the small, rural and remote communities aspect of this theme.
Allowable Costs
operating support for specific research activities undertaken by the members of the team
purchase and maintenance of equipment and other research tools, maintenance grants for common services and shared facilities
costs of data collection and maintenance of information holdings
costs of regional, national and international networking activities, including collaboration, planning, and research exchange activities directly related to the research program or project
the salary of a professional coordinator and/or administrative assistant
the salary(ies) of research assistants as appropriate
costs involved in dissemination of research findings to the practitioner and policy communities;
The full application must provide a detailed justification of all costs.
Evaluation Criteria for Peer Review
In addition to the standard CIHR criteria relating to scientific excellence, the following evaluation criteria will be applied:
Project meets objectives described above and aligns clearly with the mandates and priorities of the Institutes supporting this initiative
Potential to improve the health of Canadians or their satisfaction with their own health care or the health care system
Potential to improve the effectiveness, efficiency and equity of the Canadian health care system
Broad potential applicability of results or methods
Potential for significant advance in the development of methods/measurement approaches, and for the provision of new empirical evidence (based on natural experiments, evaluations of new interventions, or comparisons of alternative approaches already in place) that will enhance our understanding of, or facilitate the development of policy or program solutions for, one or more issues identified as priorities in this request
Has strong potential to increase research capacity/expertise in key areas of health services/policy research
Involves researchers and approaches spanning more than one CIHR theme/pillar
Clearly identifies ways in which policy/program/service decision-makers and the public will be involved in the research and/or the knowledge transfer strategies
For proposals addressing Aboriginal communities, clearly articulates a meaningful partnership with the communities in question, from initial design to final dissemination of results
Clearly articulated knowledge transfer/dissemination strategy that identifies relevant target audiences, tools, and action and evaluation plans
Involves multiple institutions/organizations and multiple disciplines
Applicants should outline interim milestones and 'deliverables', such as critical appraisals of relevant literature, workshop reports, summaries of research approach, preliminary results, that are clearly tied to a knowledge transfer strategy that begins at the outset and builds throughout the project.
How to Apply
Any investigator eligible for CIHR funding.
There are no separate application forms. You apply to CIHR on the usual forms following the regular guidelines for application. Please refer to the CIHR website at www.cihr.gc.ca under Funding Opportunities. Choose the peer review committee which is most related to the area of study of the application. Indicate in the program area on page 1 of the Research Module that this application is for the Improving Access to Appropriate Health Services for Marginalized Groups Initiative.
Contact for Further Information
1) For questions pertaining to the strategic research themes:
Terry Albert (mailto:talbert@cihr-irsc.gc.ca) , Earl Nowgesic (earl.nowgesic@utoronto.ca) or Ginette Thomas (gthomas@cihr-irsc.gc.ca)
2) For questions pertaining to the application or peer review processes:
Mary Fraser Valiquette (mfraserv@cihr-irsc.gc.ca)
