A systematic unpacking of Dr Monica O'Mullane's HIA-IM research programme: its theoretical scaffolding, methodological toolkit, community engagement protocols, implementation model design, and the institutional rewiring it seeks to achieve.
HIA-IM is structured around four interlocking Work Packages (WPs). Each generates distinct data streams that converge in WP4 to produce the final implementation model. The design is deliberately iterative: action research cycles within WP1 feed into WP2's analytical framework, while WP3's community engagement toolkit develops in parallel and informs all other WPs. Co-creation with partners is not an add-on but the fundamental operating principle.
HIA 1 (Local): Cork City Development Plan 2022–2028. Commenced October 2023. First HIA on a city development plan in Ireland. Used IPH 2021 HIA Guidance. Included a public engagement event gathering residents' lived experience as formal evidence. Report published CORA repository 2024. Case study published in Impact Assessment and Project Appraisal (2025).
HIA 2 (National): Government Climate Action Plan 2024. Commenced early 2025 with student research assistant Caithlín Sheehan. Tests the model at national policy scale where intersectoral complexity is vastly greater, involving government ministries and cross-departmental coordination.
Method: Action research cycles with HIA Steering Groups (12 members each) and policy end-users (~20 per HIA). The Steering Groups comprise intersectoral stakeholders from health, planning, environment, and community sectors. Data are gathered on the experience of doing the HIA, not just its findings.
Applies two complementary implementation science frameworks simultaneously to HIA data from WP1. CFIR 2.0 (Damschroder et al., 2022) maps the determinants of HIA implementation, particularly the outer setting (policy and institutional drivers) and inner setting (organisational capacity, resources, culture). NPT (Finch et al., 2018) maps the process work people do to embed HIA into routine practice.
The scoping review (Kenny et al., 2025, Health Promotion International) mapped 30+ years of HIA literature against all five CFIR domains, producing the first "routemap" for HIA implementation from an implementation science perspective.
Co-creating a resource to optimise inclusive community participation in HIA in Ireland. Addresses a critical gap: the IPH 2021 HIA Guidance does not include specific guidelines on community engagement. Led by Kirsty Nash (Research Assistant) with Dr Tara Kenny and Ben Harris-Roxas (UNSW). Draft presented at EPH Conference Lisbon, November 2024. Literature review on community participation in HIA ongoing (expected completion October 2025).
The Public Involvement Consultation Group includes members from Cork Environmental Forum, Cork Healthy Cities, Global Action Plan, Coalition 2030, Coast Watch Ireland, Global Health Ireland, Independent Living Group, and Social Justice Ireland.
Iterative development of a contextualised, contemporary Irish HIA implementation model by integrating and triangulating qualitative and quantitative data from all WPs. The model will synthesise: HIA process stages (IPH framework), implementation determinants (CFIR), normalisation mechanisms (NPT), community engagement protocols (WP3 toolkit), and governance structures.
The TRANSLATE-HIA knowledge translation project (HRB KTA-2024-009, Dec 2024–April 2026) will translate the emerging model into practical resources. The "Getting Going with HIA" resource and HIA FAQ infographic are being co-produced with practitioners.
O'Mullane's selection of CFIR and NPT is deliberate and justified in the protocol. CFIR captures what determines whether HIA succeeds or fails in a given institutional context. NPT captures the process work that people do to make HIA routine rather than episodic. Both are applied simultaneously to the same HIA Steering Group data, producing complementary analytical layers that neither framework could generate alone.
Consolidated Framework for Implementation Research (Damschroder et al., 2022). Five domains, ~39 constructs. O'Mullane draws particularly on outer and inner setting domains.
NPT (Finch et al., 2018) is a middle-range sociological theory examining how complex interventions become embedded and sustained. Four core constructs, each applied as an analytical lens to HIA Steering Group experiences.
How stakeholders make sense of HIA. Do they understand what it is, how it differs from other assessments, and why it matters? O'Mullane's doctoral research found that coherence failures (HIA being poorly understood) are a root cause of implementation failure.
How people are enrolled and engaged in HIA. Who commits, who champions it, who resists? The intersectoral Steering Group design is itself an intervention in cognitive participation, deliberately bringing non-health actors to the table.
The operational work of conducting HIA. Resource allocation, division of labour, skill requirements, interactional workability between sectors. Where does the actual "doing" break down? This is where institutional gatekeeping (from the Dove Gardens research) becomes visible.
How participants appraise HIA after engaging with it. Does it produce valued outcomes? Would they do it again? This maps directly to sustainability and normalisation: whether HIA becomes embedded or remains an episodic exercise.
The protocol explicitly states that the "rationale for choosing the action research design approach is to ensure the creation of the implementation model is underpinned by an iterative development... involving learning, reflection and action in the HIA approach of those involved." This means the frameworks are not applied post hoc to completed HIAs but embedded in real-time, shaping how the research team and Steering Groups reflect on their own practice.
Community involvement is a core value of HIA, enshrined in the Gothenburg Consensus (1999) alongside democracy, equity, sustainability, and ethical use of evidence. Yet the IPH 2021 HIA Guidance for Ireland, the primary procedural document for conducting HIAs, does not include specific guidelines on community engagement. WP3 exists to close this gap.
The toolkit is being co-created with the Public Involvement Consultation Group (PICG), comprising representatives from Cork Environmental Forum, Cork Healthy Cities, Global Action Plan, Coalition 2030, Coast Watch Ireland, Global Health Ireland, Independent Living Group, and Social Justice Ireland. This is not a top-down academic product but a resource shaped by the organisations and communities who would use and be affected by HIA.
A systematic literature review mapping existing evidence on community participation in HIA internationally. Led by Kirsty Nash with Dr Tara Kenny and Dr Monica O'Mullane. The review examines: what methods have been used to involve communities in HIA, at which stages of the HIA process, with what outcomes, and what barriers and facilitators have been identified.
Status: Ongoing. Expected completion October 2025 (per Global Action Plan update, July 2024).
Theoretical lens: The review likely applies equity and power analysis, consistent with O'Mullane's doctoral focus on institutional gatekeeping and whose evidence counts in policy processes.
The Cork City Development Plan HIA (WP1) included a dedicated public engagement event to gather residents' lived experience as formal evidence alongside epidemiological and planning data. This event tested community engagement methods in practice and generated empirical data on what works and what doesn't in an Irish HIA context.
The public engagement event report was published on the UCC CORA repository (2024), providing a documented case study of community voice as valid HIA evidence. Findings from this process directly feed WP3's toolkit development.
Key insight from O'Mullane's doctoral work (Dove Gardens, Derry): community voices are often formally gathered but then institutionally filtered out. The toolkit must address not just how to engage communities but how to protect and transmit that evidence through institutional gatekeeping structures.
The draft Community Engagement Toolkit was presented at two major conferences in late 2024:
Irish Global Health Network Conference (October 2024) and the European Public Health (EPH) Conference, Lisbon (November 2024). The EPH presentation is documented as: Nash, K., Kenny, T., O'Mullane, M., and Harris-Roxas, B. (2024) "Developing a community engagement toolkit for health impact assessment in Ireland," European Journal of Public Health, 34.
These presentations served dual purposes: international peer review of the draft toolkit and exposure to community engagement practices from other countries' HIA traditions (particularly Australia via Harris-Roxas and Wales via Green).
The TRANSLATE-HIA project (HRB KTA-2024-009, December 2024–April 2026) is translating HIA-IM's emerging findings into practical resources. Research Assistant Eibhlín Looney joined the team in July 2025 specifically for this work. UCC SREC ethical approval: Log no. 2025-182.
"Getting Going with HIA" Event (6 November 2025, Dr Dora Allman Room, The Hub, UCC): The first event of its kind in Ireland, bringing together ~60 practitioners from HSE, NGOs, local authorities, private sector, and academia.
Morning session: Expert roundtable chaired by Denise Cahill (Cork Healthy Cities). Speakers: Karen O'Mahony (Cork City Council, Senior Executive Planner/Urban Designer), Johnny Liu (London Borough of Tower Hamlets), Dr Margaret Douglas (Public Health Scotland), Dr Liz Green (Public Health Wales, WHO Collaborating Centre). Welcome by Prof Ella Arensman (Head, UCC School of Public Health).
Afternoon session: World Café on "Strategies for Getting Going with HIA" — a participatory method using facilitated table discussions to create a practical resource for practitioners starting HIA. Outputs: a "Getting Going with HIA" resource document and an HIA "Frequently Asked Questions" infographic.
Event recordings available via HEAnet media services. Webinar recordings of reflections on the Cork CDP HIA process are also available.
The Community Engagement Toolkit will integrate: (1) the systematic literature review findings, (2) empirical lessons from the Cork CDP HIA public engagement, (3) peer feedback from EPH Conference and Irish Global Health Network, (4) practitioner insights from the World Café, and (5) ongoing data from the Climate Action Plan HIA (HIA 2) community engagement processes.
The final toolkit becomes a component of the overarching HIA Implementation Model (WP4), providing specific guidance on: when and how to engage communities at each HIA stage, how to ensure marginalised and disadvantaged populations are meaningfully included, how to document and protect community evidence through institutional processes, and how to feedback HIA outcomes to communities.
Status: Synthesis phase expected late 2026. The toolkit will be published as an open-access resource, stored on UCC CORA, and disseminated through TRANSLATE-HIA networks.
The HIA Implementation Model under construction is not a simple procedural flowchart. It is a multi-layered architecture that maps the process of HIA against its institutional determinants, normalisation mechanisms, community engagement requirements, and governance structures. The model is being developed iteratively through triangulation of data from all four Work Packages.
CFIR Outer Setting. Policy mandates (Healthy Ireland, Climate Action), legislation, political will, sectoral norms, inter-jurisdictional peer influence. Maps the macro-conditions that enable or obstruct HIA. O'Mullane's doctoral finding: without institutional mandate, even high-quality HIAs are "left to gather dust on shelves."
CFIR Inner Setting. Available expertise, funding, data, training, organisational culture. Kenny et al. (2025) found "availability of resources" (skills, information, financial and human capacity) is the dominant implementation barrier in HIA globally. The model specifies minimum resource thresholds for each HIA depth level.
The operational spine: six stages from the IPH 2021 HIA Guidance (screening, scoping, appraisal, reporting, decision-making, monitoring/evaluation). Three depth levels: desk-based (2–6 weeks), rapid (~12 weeks), comprehensive (~6 months). Each stage has specific implementation requirements from the layers above and below.
NPT constructs mapped onto each HIA stage. Coherence (sense-making at screening/scoping), Cognitive Participation (stakeholder enrolment at scoping), Collective Action (operational delivery at appraisal), Reflexive Monitoring (evaluation of outcomes). These explain how HIA moves from episodic project to embedded routine practice.
WP3 Toolkit. Guidance on when and how to involve communities at each HIA stage, equity-focused methods for reaching marginalised populations, documentation protocols for community evidence, and mechanisms for feeding back HIA outcomes to communities. This layer addresses the democratic and equity values of the Gothenburg Consensus.
The model is designed to be prescriptive but adaptable: it specifies what needs to happen at each layer and stage but allows local adaptation based on context (policy level, sectoral setting, resource availability). The dual-scale testing (local CDP vs. national Climate Action Plan) validates which elements are universal and which are scale-dependent.
Tracking the full arc from O'Mullane's doctoral study (supervised by Dr Aodh Quinlivan, Dept. Government & Politics, UCC, 2008) through to the current HIA-IM programme and its knowledge translation outputs.
O'Mullane is a qualitative-dominant mixed-methods researcher. Her training in political science under Dr Aodh Quinlivan means she approaches HIA as a political process, not merely a technical one. Her methods are chosen to capture institutional dynamics, power relations, and the lived experience of doing HIA in real institutional contexts.
The non-negotiable methodological spine. Iterative cycles of planning, action, observation, and reflection. Applied in real-time during HIA conduct, meaning the research team and Steering Groups are simultaneously doing HIA and reflecting on how they are doing it. Based on Bradbury (2022).
With HIA Steering Group members (Group A, ~12 per HIA) and policy end-users (Group B, ~20 per HIA) from city council and government ministries. Interview schedules structured around NPT and CFIR constructs. Captures the institutional texture that quantitative methods cannot.
A method O'Mullane developed in her GENOVATE gender equality work (published Archibong et al., 2016, International Journal of Organisational Diversity). Functions as both a data collection and organisational learning tool. Steering Group members reflect on their experience of HIA participation.
Her doctoral method, carried into HIA-IM. Tracks how institutional factors, stakeholder relationships, and implementation dynamics evolve over the full life cycle of each HIA, not just at a single point in time.
Used at the "Getting Going with HIA" event (Nov 2025). Facilitated roundtable discussions with rotating participants. Generates practitioner insights on strategies for starting HIA. Based on Brown & Isaacs' World Café method. Outputs directly feed the "Getting Going" resource and WP3 toolkit.
Used in the Cork CDP HIA to gather residents' lived experience as formal evidence. Reports published on CORA repository. Positions community voice alongside epidemiological data and planning evidence. Addresses HIA's equity values.
Kenny et al. (2025) mapped HIA literature against all five CFIR 2.0 domains to produce a "routemap" for HIA implementation. Novel application of CFIR to HIA. Published in Health Promotion International (DOI: 10.1093/heapro/daaf080).
Systematic analysis of development plans, climate strategies, IPH guidance, institutional responses to HIA recommendations. Captures the formal policy trail from HIA findings through to (non-)adoption by decision-makers.
Interview and reflection data coded against NPT constructs (coherence, cognitive participation, collective action, reflexive monitoring) and CFIR domains (outer setting, inner setting, innovation, individuals, process). Dual coding provides complementary analytical layers.
WP4 integrates qualitative data (interviews, reflections, policy analysis) with process data (action research cycles) and community engagement data (WP3). Convergence, complementarity, and divergence across data streams are systematically analysed to build the implementation model.
The ecosystem is constructed to mirror the intersectoral reality that HIA requires. Health is socially determined by decisions made in planning, transport, housing, environment, and employment. The Steering Groups deliberately recruit across these sectors. The dual-scale design (local CDP + national Climate Action Plan) tests whether the same implementation model holds across fundamentally different institutional contexts.
The all-island IPH 2021 HIA Guidance, the primary procedural document for HIA in Ireland, lacks specific guidance on community engagement. WP3 addresses this directly, but the gap means every HIA conducted in Ireland to date has had to improvise community participation. The toolkit aims to fill this at the national guidance level.
The implementation model has been primarily tested at local scale (Cork CDP). HIA 2 (Climate Action Plan) is the first test at national scale, where intersectoral complexity is fundamentally different: government ministries, cross-departmental politics, national vs. local mandate structures. Whether the same CFIR/NPT framework holds across scales remains an open empirical question.
O'Mullane's doctoral finding (2008) remains the central problem: HIA evidence is often gathered but institutionally filtered out before reaching decision-makers. The implementation model must address not just how to do HIA but how to construct institutional pathways that protect evidence transmission. This is fundamentally a governance design problem.
HIA-IM is funded through 2026, TRANSLATE-HIA through April 2026. The ultimate test of the implementation model is whether HIA becomes embedded in Irish policy-making after project funding ends. NPT's reflexive monitoring construct is designed to assess this, but the answer won't be known until the post-project period.
The HIA-IM methodology is qualitative-dominant. While appropriate for understanding institutional dynamics, the model does not currently incorporate quantitative health impact modelling, GIS spatial analysis, or computational approaches to health determinant mapping. Integrating these would strengthen the appraisal stage of HIA.
The ultimate goal is normalisation: HIA becoming as standard as Environmental Impact Assessment in Irish planning. This requires legislative or regulatory change, sustained capacity building, and the kind of institutional culture shift that the implementation model seeks to enable. The Cork Healthy Cities platform provides a governance test-bed.
Collaboration with Dr Jarmila Pekarcikova at Trnava University on "Creation of an interactive educational online platform to support teaching of HIA methodology" (KEGA funded, 2025–2027). This would translate the HIA-IM knowledge base into an educational resource with international reach.
The Climate Action Plan HIA (HIA 2) positions health at the centre of climate policy. If successful, this establishes a precedent for mandatory health consideration in all future Climate Action Plans, linking HIA to Ireland's legally binding carbon budgets and 51% emissions reduction target by 2030.
The Cork CDP HIA demonstrated that city development plans are implicit health interventions. The aspiration is for architects, urban designers, and planners to adopt HIA as a standard tool in the design process, recognising that spatial decisions about housing, density, green space, and transport are fundamentally decisions about population health and wellbeing.
The conventional reading of O'Mullane's work positions HIA as a technical tool for assessing health impacts of policy. But her research programme, read as a whole, reveals something more fundamental.
HIA, as O'Mullane constructs it, is an intervention in institutional behaviour. It restructures who has voice in decision-making (community engagement protocols), what counts as valid evidence (lived experience alongside epidemiology), and where health sits in the organisational hierarchy (intersectoral Steering Groups that force non-health actors to engage with health consequences). The implementation model she is building is not a method for doing better assessments. It is a model for rewiring institutional architecture so that health equity becomes a structural input to governance.
This reframe matters for architecture and resilient design. If the built environment is a primary health determinant, and if city development plans are implicit health interventions, then the institutional systems that produce those plans are themselves health infrastructure. O'Mullane's HIA-IM is, at its core, an attempt to redesign that infrastructure. Not the buildings. The decision systems that produce them.