Perfect timing for a national fruit and vegetable nutrition policy

Selecting cross-sector partners to work with the federal government on promoting healthy eating

In response to child overweight and obesity being made a public health priority, Health Canada developed a series of healthy eating and education awareness initiatives1. The final and third initiative was a social marketing campaign, the Eat Well Campaign: Food Skills (EWC), that promoted family meal planning and preparation to Canadian parents. Health Canada collaborated with cross-sector partners from the food retail industry, the media and the health sector to extend the reach and effectiveness of the EWC. Leveraging resources and expertise are important incentives for governments to work with partners. Developing solutions to address complex health problems, such as improving dietary behaviors, is complicated and requires the joint action of multiple sectors from the government, private industry and civil society2,3.

The adoption of healthy eating initiatives by cross-sector partners, and motivations for organizations from different sectors to collaborate with a federal body have not been examined. Given that adoption can influence an intervention’s effectiveness4, it is important to understand the factors involved, particularly in the context of adopters from multiple sectors. The objective of this qualitative study was to describe factors that influenced the adoption of the EWC. Findings were based on telephone interviews with 18 of Health Canada’s partners. Five main recommendations for public health organizations were derived from the analysis of these interviews5.

  1. Use a targeted approach to recruit partners
    The adoption rate among cross-sector partners appeared to be extremely high. All partners that were directly invited to participate in the EWC agreed to partner with Health Canada. These partners were intentionally sought out by Health Canada through specific networks or invitations to respond to calls for proposals. Pre-selecting and targeting partners that will likely respond well to an initiative’s objectives appears to be a very effective method for recruiting partners.
  2. Find partners that are highly compatible
    All partners that agreed to adopt the EWC had some level of compatibility with the campaign’s initiatives, values, audience or staff. Compatibility is a known factor that drives adoption of an initiative by an organization6. Having a good fit, particularly when it comes to organizational values, appears to be more important than profit oriented or non-health related missions such as entertainment. We recommend identifying partners that would have a good innovation-systems fit with the public health initiative7.
  3. Use social networks (peer pressure) with high opinion leadership
    Using established networks to recruit organizations provided an automatic partnership base. Some organizations participated, because it was part of their mandate within a specific network, while others felt it would have been impossible to say no given that their entire professional network was expected to adopt the EWC. Using networks with high opinion leadership value is recommended to recruit partners8.
  4. Use the agency’s reputation as leverage
    Collaborating with or being associated with Health Canada was a major perceived relative advantage of the EWC. Organizations felt that working with a reputable organization would help improve their credibility and social image among their audience or clients. Relative advantages are among the most important factors influencing adoption. Social prestige, of working with Health Canada, is a prominent sub-dimension of relative advantages that is known to have a strong impact on adoption9. Prominent agencies with high levels of credibility can easily leverage their reputation to recruit the most desirable partners.
  5. Understand adoption barriers
    Only partners that were invited through a third party appeared to reject the EWC. Nothing, however, is know about this group of nonadopters, because they were not made known by the third party to Health Canada and could not be included in the study. Health Canada speculated that non-adoption was likely due to organizations having a smaller size with fewer resources and less capacity to collaborate on initiatives outside of their day-to-day business.Not having any information about this group’s reasons for rejecting the EWC has left a knowledge gap unfilled about non-adoption, thus it recommended to routinely collect information about reasons for not adopting an initiative. This is particularly important to better understand how to include a diversity of organizations to ensure multiple sectors implicate themselves and are represented in concerted public health initiatives.

Taking into consideration the different needs and expectations of organizations from diverse sectors is important when collaborating with cross-sector partners. Despite the probable differences of organizational missions between partners from the food retail industry, the media and the health sector, there were commonalities among these partners that led to collaborating with Health Canada and adopting the EWC such as shared values. In Canada, prominent federal bodies like Health Canada with strong reputations are desirable partners and these organizations can leverage their notoriety to attract the highest quality partners to help advance population health goals.

  1. Public Health Agency of Canada. Curbing childhood obesity: An overview of the federal, provincial and territorial framework for action to promote healthy weights. Ottawa: PHAC; 2010.
  2. Riley BL et al. Knowledge to action for solving complex problems: Insights from a review of nine international cases. Health promotion and chronic disease prevention in Canada. 2015;35(3):47-53.
  3. Vandenbroek P, Goossens J, Clemens M. Tackling obesities: Future choices – buliding the obesity systems map UK: Government Office for Science; 2007 [cited 2015 July 27]. Available from:
  4. Virginia Tech. Re-aim: A model for the planning, evaluation, reporting and review of translational research and practice Blacksburg, VA: Virginia Polytechnic Institute and State University; 2014 [cited 2015 July 29]. Available from:
  5. Fernandez M et al. Factors influencing the adoption of a healthy eating campaign by federal cross-sector partners: A qualitative study. BMC public health. 2016;In Press.
  6. Tornatzky LG, Klein KJ. Innovation characteristics and innovation adoption-implementation: A meta-analysis of findings. IEEE Transactions on Engineering Management. 1982;EM-29(1):28-45.
  7. Greenhalgh T et al. Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Q. 2004;82(4):581-629.
  8. Dearing JW. Improving the state of health programming by using diffusion theory. J Health Commun. 2004;9 Suppl 1:21-36.
  9. Greenhalgh T. Diffusion of innovations in health service organisations a systematic literature review. 2005.