Project: Enhancing effective implementation of national guidelines on health promotion: developing concrete tools and handles for improving implementation at the local level

Enhancing effective implementation of national guidelines on health promotion: developing concrete tools and handles for improving implementation at the local level

Dit is de samenvatting van de aanvraag.

Enhancing effective implementation of national guidelines on health promotion at the local level is the main focus of this research proposal. The Ministry of Health has indicated 5 national priorities (spear-points) in their Prevention Memorandum: smoking, excessive alcohol use, overweight, depression and diabetes. To stimulate local governments to pay attention to these priorities, guidelines have been published on four of these themes (not yet on diabetes). These guidelines aim to incorporate the national spear-points in the local health policy as well as to implement (effective) interventions at the local level in a comprehensive manner. To achieve this, the guidelines offer an overview of the state of the art of both epidemiological and policy-related information and the best local preventive interventions (proven effective or at least promising) currently available. Regional Public Health Services (RPHSs) advise local governments in planning, implementing and executing local health policy and interventions. The guidelines serve as a means to offer the best state of the art in this respect. Research results from the Health Inspectorate and preliminary results from a very recent study of the Centre for Healthy Living (Centrum Gezond Leven; CGL), part of the National Institute for Public Health and the Environment(RIVM), however, show that the RPHS and local authorities use the guidelines only partially, if at all. This proposal aims to discover the reasons for this poor implementation result and to develop concrete instruments to enhance local implementation. Therefore its main focus of interest is on the actors and factors that play a significant role in the complex process of implementing the national guidelines at the local level (i.c. RPHSs, local governments and other local stakeholders). The perspective chosen is that of the RPHS as a central (regional) actor between the national and local level and more specifically its functioning in relation to the local governments and other local stakeholders. Which hindering and facilitating factors in implementing the guidelines are encountered by those working at different organisational levels (board, staff and professionals) Both in their own organisation and in their collaboration with local governments and other local stakeholders. Collaboration between all system levels in and between organisations to a large extent determines the level of successful collaboration (internally as well as externally), which is crucial in relation to effective implementation (Jansen, 2007). In addition to the role of the RPHS, also experiences with the implementation of guidelines by the other central actors such as local governments and other local stakeholders (schools and other health promoting organizations) will be studied.

This study elaborates on the results of an inventory study by the CGL (RIVM; in concept) which gathered data on the use of the guidelines in general. Our study will elaborate on the processes that influence guideline-use at the local level. By studying the ‘black box’ of the actual processes in the collaboration between the RPHS, local governments and other local stakeholders, more insight will be gained in the factors that are conditional for successful local implementation of national prevention guidelines. Such factors may refer to aspects of collaboration and organisation but also to quality or usability aspects of the guidelines itself. Based on these hindering and facilitating factors in the local implementation process, recommendations for strategies and tools for a more effective implementation will be formulated. These recommendations will be pilot-implemented and evaluated in two RPHSs. Finally, the evaluation results are translated to concrete tools and handles (such as workshops, courses, a helpdesk-function or recording digital knowledge into the GCL website) for more effective implementation of national guidelines at the local level.