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The purpose of this paper is to use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences inter-relate in the implementation of integrated transitional care out of hospital in the English National Health Service.

The authors conducted an ethnographic case study of a hospital and surrounding services within a large urban centre in England. Specific methods included qualitative interviews with patients/caregivers, health/social care providers, and organizational leaders; observations of hospital transition planning meetings, community “hub” meetings, and other instances of transition planning; reviews of patient records; and analysis of key policy documents. Analysis was iterative and informed by theory on institutional logics and institutional entrepreneurship.

Organizational leaders at the meso-level of health and social care promoted a partnership logic of integrated care in response to conflicting institutional ideas found within a key macro-level policy enacted in 2003 (The Community Care (Delayed Discharges) Act). Through institutional entrepreneurship at the micro-level, the partnership logic became manifest in the form of relationship work among health and social care providers; they sought to build strong interpersonal relationships to enact more integrated transitional care.

This study has three key implications. First, efforts to promote integrated care should strategically include institutional entrepreneurs at the organizational and clinical levels. Second, integrated care initiatives should emphasize relationship-building among health and social care providers. Finally, theoretical development on institutional logics should further examine the role of interpersonal relationships in facilitating the “spread” of logics between macro-, meso-, and micro-level influences on inter-organizational change.

Immigrant youth face both unique and disproportionate barriers to sexual health. Targeted sexual health education to redress these disparities requires creative and inclusive approaches that consider personal and community challenges and strengths. This study piloted a novel intervention: SExT: Sex Education by Theatre, a theatre-based, culturally-relevant, participatory action research programme delivered in an immigration destination neighbourhood in Toronto, Canada.

Nineteen youth were trained as peer educators. They participated in theatre-based workshops on sexual health topics which culminated in a performance for local peers. Mixed methods evaluation included surveys which investigated changes in personal and social development over three time-points (pre, post, 4-month follow-up). The impact of the intervention on peer educators was explored in greater depth using qualitative peer interviews and focus groups.

Quantitative study findings indicated that peer educators experienced significant improvements in personal growth, social inclusion and social engagement after participating in SExT and these improvements were maintained at follow-up. Thematic qualitative analysis further indicates that meaningful involvement in a sex education theatre intervention may protect against adverse outcomes and promote self-actualization, connection and active citizenship.

This research stands out for its innovative approach to addressing sexual health disparities among immigrant youth in Toronto using culturally relevant theatre-based peer education. SExT may serve as a model for sexual health interventions for newcomer youth and other priority groups in diverse contexts.