Cross-sector cooperation in health-enhancing physical activity policymaking: more potential than achievements?

Self Cite

BackgroundThe present study aims to test out contextually tailored interventions to increase evidence-informed health-enhancing physical activity policy-making in two Danish municipalities.MethodsThe study was performed as experiments in natural settings. Based on results from a pre-intervention study defining the needs and contexts of the two settings, the interventions were developed based on logical models. The interventions aimed at increasing the use of knowledge in policy-making, primarily via strengthening intersectoral collaboration. The interventions were evaluated via pre-, post- and 12-month follow-up questionnaires and qualitative interviews were carried out prior to the intervention start.ResultsThe use of knowledge changed in several ways. In one municipality, the use of stakeholder and target group knowledge increased whereas, in the other municipality, the use of research knowledge increased. In both municipalities, the ability to translate knowledge to local context, the political request and the organisational procedures for use of knowledge increased during the interventions. There was some variation between the two settings, which shows the importance of tailoring to context. Most of the changes were diminished at the 12-month follow-up.ConclusionContextually tailored interventions have the potential to increase evidence-informed policy-making on health-enhancing physical activity. However, this finding needs to be tested in larger samples and its sustainability must be strengthened.Electronic supplementary materialThe online version of this article (10.1186/s12961-018-0290-4) contains supplementary material, which is available to authorized users.

Section: Methodsmentioning

confidence: 99%

Contextually tailored interventions can increase evidence-informed policy-making on health-enhancing physical activity: the experiences of two Danish municipalities

Bertram¹,

Loncarevic²,

Radl-Karimi³

et al. 2018

Self Cite

“…The research designs that top the hierarchy of evidence are primarily applicable to relatively simple, sequential interventions with a clear beginning and end, such as a medication that works through a tightly coupled biological or physical mechanism [ 21 ]. In health promotion, the greatest benefits are currently expected from interventions that simultaneously target the individual and their environment and comprise multiple components that are intended to be co-constructed in the local context [ 11 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Improving health promotion through central rating of interventions: the need for Responsive Guidance

Kok

Bal

Roelofs

et al. 2017

BackgroundIn several countries, attempts are made to improve health promotion by centrally rating the effectiveness of health promotion interventions. The Dutch Effectiveness Rating System (ERS) for health promotion interventions is an improvement-oriented approach in which multi-disciplinary expert committees rate available health promotion interventions as ‘theoretically sound’, ‘probably effective’ or ‘proven effective’. The aim of this study is to explore the functioning of the ERS and the perspective of researchers, policy-makers and practitioners regarding its contribution to improvement.MethodsWe interviewed 53 selected key informants from research, policy and practice in the Netherlands and observed the assessment of 12 interventions.ResultsBetween 2008 and 2012, a total of 94 interventions were submitted to the ERS, of which 23 were rejected, 58 were rated as ‘theoretically sound’, 10 were rated as ‘probably effective’ and 3 were rated as ‘proven effective’. According to participants, the ERS was intended to facilitate both the improvement of available interventions and the improvement of health promotion in practice. While participants expected that describing and rating interventions promoted learning and enhanced the transferability of interventions, they were concerned that the ERS approach was not suitable for guiding intervention development and improving health promotion in practice. The expert committees that assessed the interventions struggled with a lack of norms for the relevance of effects and questions about how effects should be studied and rated. Health promotion practitioners were concerned that the ERS neglected the local adaptation of interventions and did not encourage the improvement of aspects like applicability and costs. Policy-makers and practitioners were worried that the lack of proven effectiveness legitimised cutbacks rather than learning and advancing health promotion.ConclusionWhile measuring and centrally rating the effectiveness of interventions can be beneficial, the evidence based-inspired ERS approach is too limited to guide both intervention development and the improvement of health promotion in practice. To better contribute to improving health promotion, a more reflexive and responsive guidance approach is required, namely one which stimulates the improvement of different intervention aspects, provides targeted recommendations to practitioners and provides feedback to those who develop and rate interventions.

“…In Spain, most of secondary and tertiary care is public and paid on a salary basis, which facilitates the working gatekeeping. Emphasising inclusive policy dialogue with secondary and tertiary care providers (in the Slovakia case but also important in Spain) could create a positive environment for developing shared goals and care coordination pathways, and promoting gatekeeping implementation (Table 4) [60].…”

Section: Discussionmentioning

confidence: 99%

The impact of governance in primary health care delivery: a systems thinking approach with a European panel

Espinosa-González

Delaney

Marti

et al. 2019

Background Enhancing primary health care (PHC) is considered a policy priority for health systems strengthening due to PHC’s ability to provide accessible and continuous care and manage multimorbidity. Research in PHC often focuses on the effects of specific interventions (e.g. physicians’ contracts) in health care outcomes. This informs narrowly designed policies that disregard the interactions between the health functions (e.g. financing and regulation) and actors involved (i.e. public, professional, private), and their impact in care delivery and outcomes. The purpose of this study is to analyse the interactions between PHC functions and their impact in PHC delivery, particularly in providers’ behaviour and practice organisation. Methods Following a systems thinking approach with data obtained through a three-round European Delphi process, we developed a framework that captures (1) the interactions between PHC functions by analysing correlations between PHC characteristics of participating countries, (2) how actors involved shaped these interactions by identifying the actor and level of devolution (or fragmentation) in the analysis, and (3) their potential effect on care delivery by exploring panellists’ opinions. Results A total of 59 panellists from 24 countries participated in the first round and 76% of the initial panellists (22 countries) completed the last round. Findings show correlations between governance, financing and regulation based on their degree of decentralisation. This is supported by panellists, who agreed that the actors involved in health system governance determine the type of PHC financing (e.g. ownership or payment mechanisms) and regulation (e.g. competences or gatekeeping), and this may impact care delivery and outcomes. Governance in our framework is an overarching function whose impact in PHC delivery is mediated through the degree of decentralisation (both delegation and devolution) of PHC financing and regulation. Conclusions The application of this approach in policy implementation assessment intends to uncover limitations due to poor accountability and commitment to shared objectives. Its application in the design of health strategies helps foresee (and prevent) undesired or unexpected effects of narrow interventions. This approach will assist in the development of the realistic and long-term policies required for health systems strengthening. Electronic supplementary material The online version of this article (10.1186/s12961-019-0456-8) contains supplementary material, which is available to authorized users.