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Aims: This study has internationally tested and refined a framework for institutionalizing and practicing health impact assessment (HIA). HIA is conducted differently in different contexts and recently HIA experts suggest that broader context, in which HIAs are carried out is linked to technical aspects of the HIA. Materials and Methods: A survey internationally attained viewpoints of academics and practitioners (n = 38) on the identified parameters of the framework including factors influencing HIA. Structural equation modeling (SEM) through SmartPLS was used to test for relations between the factors. Finally, the model was modified to reach an appropriate fit. Results: The framework emphasizes HIA Context, HIA Capacities including Institutional, Technical and Participation capacities, HIA Content, and HIA Outcomes as key factors in implementation and practice of HIA. This framework reflects the broad range of factors that influence HIA. All broad factors were perceived as significant influences on the practice of HIAs. Some fit measures, i.e., the standardized root mean square residual appear to be in the acceptable range. Conclusion: We have demonstrated the utility of SEM for developing and testing a framework to do HIA in different country contexts. [ABSTRACT FROM AUTHOR]