Table 4.

Key themes from in-depth interviews with HIA participants^a

Domain	Themes	Frequency of Themeb	Illustrative Quotations
HIA impact on community social and built environment	HIA changed decision-makers’ opinions	Many	“I think a lot of the issues that we mentioned [in the HIA] were things that the community had been talking about for a long time… Having it in writing, I think, made a big difference… made policy-makers really listen more.”
	HIA impacted partnerships in community	Most	“I think [the HIA process] did increase collaboration, and certainly influenced the different partners that became involved. There were some groups that were formed specifically to try to help move this [work] along.”
	HIA increased understanding of connection between health and built environment	Most	“We conducted a pre-meeting survey [at community meetings] to… measure awareness of the HIA and awareness of how it’s connected to health…When they did the post-survey… it seems that there was quite an increase in terms of folks reporting on their understanding that transit was connected to different health outcomes.”
	HIA impacted physical or built environment	Many	“One of the things that was very important to use when we designed those neighborhood [bus] routes was to make sure that those routes had a variety of different services that the community could [access]. For instance, on every one of those neighborhood routes, we tried to make sure there was a grocery store, parks, healthcare facilities, so that a person that was transit-dependent wouldn’t have to make a transfer to a variety of different routes.”
Inclusion of equity principles in HIA	HIA process explicitly considered at-risk subpopulations	Most	“In our findings we noted the disproportional impacts on some populations. In our analysis we made sure that we highlighted which groups in the population are always experiencing inequities about how their mobility can be impacted.”
	Participation of vulnerable communities influenced outcomes	Most	“At almost every meeting I would say that there were suggestions and recommendations that came from the public that influenced even small changes to routes and helped us really make a decision that was community based. I think that was really integral in getting the support that we did from the community and the city council as well.”
	HIA impact on health equity was explicitly noted	Many	“My position on health equity is that by elevating voices to the decision-making table that aren’t traditionally involved in the conversation, it inevitably changes the outcome and the decisions by making sure that there is more information taken into account. Sometimes that information is shared and ignored, but I don’t think that was the case here.”
HIA impact on determinants of health equity	HIA impacted community-government relationships	Some	“One of the biggest barriers that we saw change a little bit through the process was trust and trust building, trusting the government… I think as a result of this HIA, we started to rebuild community trust, at least with the city and the kinds of things that we can do as a city agency to try to mitigate those environmental injustices.”
	HIA impacted distribution of health-promoting resources	Many	“For the older adults, they are in a rural area, so they don’t have very good access to [things] like healthcare services or pharmacies or anything related to healthcare. The big impact is connecting them better [via transit] to areas where there would be more services available.”
	HIA impacted distribution of exposure to environmental risks	Some	“This housing project is built in the inside of a curve of a freeway [and] there were a number of environmental concerns that were raised. The children and probably the adults had asthma at higher rates than the population as a whole. The recommendations were very specific around the housing units themselves [and included putting] in air conditioning units which are designed differently so they don’t create that same propensity for mold, sealing the windows, and redesigning the doors.”

^aOnly topics that were mentioned across at least 5 HIAs were categorized into themes

^bSome = 5–9 HIAs; many = 10–18 HIAs most = 19–27 HIAs