Realizing a carbon-neutral healthcare system: a co-created Theory of Change in Catalonia, Spain
Barcelona Institute for Global Health (ISGlobal), Barcelona
How they used Delve
Climate and health researchers at ISGlobal Barcelona used Delve to code focus group transcripts from 12 Catalan healthcare and climate stakeholders, working from open and process coding through focused and axial coding to categories and themes, and building a Theory of Change of nearly two hundred events for a net-zero healthcare system.
“Data from focus group transcripts were analyzed using Delve qualitative software version #1804 [22]. Data analysis was carried out concurrently with data collection through initial, intermediate, and advanced stages. Multiple methods drawn from deductive and inductive Thematic Analysis and Grounded Theory approaches were applied iteratively to achieve increasing levels of conceptual and theoretical abstraction.”
- Field
- Climate and health; a co-created Theory of Change for reaching a 'smart net zero' healthcare system in Catalonia
- Data
- Iterative virtual focus group workshops recorded on Zoom and transcribed verbatim, plus written feedback rounds, with 12 stakeholders - researchers, government officials and healthcare professionals working in the Catalan healthcare system and/or on climate action; participants also viewed and edited a SWOT matrix and a co-creation canvas on Miro during the sessions
- Approach
- Participatory Theory of Change design combining deductive and inductive thematic analysis with grounded theory techniques, applied iteratively in three stages alongside data collection. Initial stage: open coding with descriptive codes, deductive coding against a predefined frame plus inductive codes for what fell outside it, process coding of actions and events as 'subject + action' statements, and triangulation against codes participants had written themselves on a virtual canvas. Intermediate stage: focused coding to review, compare and refine codes, grouping them into categories, plus visualised axial coding to represent sequential relationships. Advanced stage: inductive thematic coding to build higher-level themes. CFIR and the Multiple Streams Framework informed the predefined frame.
- Data types
- Focus groups
Abstract
Abstract Amid growing efforts to mitigate climate change in healthcare systems, there is a need to better understand the complex social and political processes by which a healthcare system can progress towards “net zero” goals. We aimed to gather stakeholders’ perspectives to explain this process by applying a qualitative Theory of Change (ToC) co-creation methodology in the subnational healthcare system of Catalonia, Spain. Iterative virtual focus group interviews and written feedback rounds gathered the perspectives of 12 stakeholders, including researchers, government officials and healthcare professionals working in the Catalan healthcare system and/or climate action. Thematic and axial coding on focus group transcripts identified themes, categories and relationships. A ToC consisting of a sequence of nearly two hundred events envisioned by stakeholders to reach a long-term desired change of a “smart net zero” healthcare system was developed. The need for simultaneous top-down and bottom-up change was recognized, with identification of key stakeholder groups. Events were categorized into four “core change pathways” (policy, industry, healthcare institutions’ and healthcare workers’ pathways) and six “supporting processes” (governance, participation and collaboration, finance, digitalization, knowledge production and knowledge dissemination). The sequence of events in every pathway was further categorized into five stages of change: motivation, commitment, planning, implementation, and monitoring and evaluation. A ToC approach was useful to understand context-specific political, logistical, and social constraints and opportunities for different types of stakeholders to contribute to change towards a “net zero” healthcare system.
Citation
Olena Zotova, Ilija Sazdovski, Miguel Angel Martinez, Niheer Dasandi, Carla Oliva, Jordi Pujadas i Rovira, Cristina Iniesta Blasco, Francesca de'Donato, Murchana Roychoudhury, José Chen-Xu, Maria Nilsson, Cathryn Tonne (2025). Realizing a carbon-neutral healthcare system: a co-created Theory of Change in Catalonia, Spain. Oxford Open Climate Change. https://doi.org/10.1093/oxfclm/kgaf018