Structural Competency in Public Health and Social Service Organizations through the Lens of New Mexico Open Access

Smith, Tracy (Summer 2022)

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While structural competency has been shown to be influential for medical education, public health and social service agencies around the world have not implemented the structural competency framework and training; there is a need to demonstrate how it can be effective in these settings. This study collected and analyzed qualitative data from five key informant interviews and one autoethnographic journal to answer the question, ‘how have the New Mexico Human Services Department (HSD) and the Doña Ana Wellness Institute (DAWI) implemented structural competency in their organizations?’ The study used the Consolidated Framework for Implementation Research (CFIR) as a guide for both data collection and analysis. Research objectives included developing case studies of the New Mexico Human Services Department implementation of structural competency and the Doña Ana Wellness Institute implementation of structural competency, developing templates of each implementation, describing similarities and differences between the two projects, and compiling lessons learned to enable other similar organizations to implement structural competency. The study created a preliminary foray into the implementation of structural competency in non-medical settings, specifically social service, public health, and governmental organizations and is the first to use CFIR as a guide for explaining structural competency implementation.

Table of Contents

Introduction   1

Background and Rationale    1

Problem Statement   2

Purpose Statement    3

Research Objectives  3

Significance    3

Acronyms       4

Operational Definition of Terms       4

Literature Review      6

Theoretical Framework: Consolidated Framework for Implementation Research (CFIR)    6

Defining Structural Competency       9

Foundations and Background 11

Applications of Structural Competency        16

Medicine and Medical Education      16

Other Contexts          24

Conclusion     30

Methodology 32

Introduction   32

Research Objectives  32

Research Design        32

Theoretical Framework         33

Population and Sample | Recruitment and Enrollment        37

Data Collection          38

Data Analysis Methodology   39

Results 43

Description of Participants    43

New Mexico Human Services Department Implementation of Structural Competency      45

Introduction   45

Planning         46

Engaging        55

Executing       56

What’s Next   59

Doña Ana Wellness Institute Implementation of Structural Competency   59

Introduction   59

Planning         60

Planning/Engaging     70

Engaging        72

Executing and What’s Next   77

Process Map of HSD and DAWI Implementation      80

Comparison   81

Similarities     82

Differences    89

Conclusions, Implications, Recommendations          92

Discussion of Key Results      92

Lessons Learned from Both Implementations          93

Strengths and Limitations      97

Implications   98

Recommendations    99

Conclusion     99

References     101

Appendix        107

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