Collaboration between practice, policy and research in local public health in the Netherlands
Introduction
Public health includes: (i) policy, as it is inherently a political enterprise; (ii) practice, as policies need to be implemented to create social action and to organise service delivery; and (iii) research, to assess the prevalence and determinants of health problems and the effectiveness of activities. Ideally, policy, practice and research should be collaborative and mutual dependent partners to strengthen public health and to increase its evidence base. Evidence surrounding public health actions inevitably raises ethical, technical, practical, political, organisational, and economic issues, making the evidence extremely complex [1], [2], [3], [4]. The assumption that long-lasting collaboration between practice, research, and policy will result in more solid evidence and higher quality standards in public health is widely supported [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]. History indicates that a link between research, practice, and policy is difficult to establish. Even today, concerted actions by public health policy, practice, and research are still rare.
Given this background, our research question was: which barriers prevent the collaborative development of public health practice, policy, and research and how can the gaps between these fields be bridged? We defined successful collaboration as concerted action continued beyond the initial funding period of usually four years. Continuation after the extra funding has stopped requires intrinsic motivation on the part of the partners, rather than external obligation. We studied the practical strategies1 of collaboration cases concerning six different local public health problems. Practical strategies are defined here as specific techniques to develop sustainable collaboration based on theoretical methods in ways that fit the population and the context. The term practical strategy relates to the question ‘how to do’, or in other words, ‘how did we promote collaboration’ ([21], pp. 318–320). We restricted our study to collaboration processes at the local level, namely the collaboration between local government of Maastricht and surrounding villages, their Regional Public Health Service (GGD), and University Maastricht. This article describes why sustained collaboration was successfully achieved in three of these cases, but not in three others. The article also elaborates on whether sustained collaboration leads to more solid evidence about public health activities. It therefore contributes to the development of collaboration strategies between the component areas of public health [22].
Section snippets
Methods
To answer the research question, we used a multiple case study design. The six cases were intended collaborations between 1991 and 2005 covering the domains of policy, practice, and research. Together, these cases are representative examples of public health problems and offer clear illustrations of public health problems in general (see Box 1). Before analysing the cases, we took four preparatory steps to define practical strategies so that we could explain the absence or presence of success.
Results
The results are summarised in Table 3. In terms of success, three of the six projects achieved sustained collaboration beyond the initial funding period. The successful cases, namely hepatitis B, Schoolbeat, and Heartbeat, had much higher total scores (35, 53, and 54, respectively; maximum score = 60) than the unsuccessful cases (24, 10 and 25). Therefore, we tentatively suggest a cut-off point for success between 25 and 35 (around 50% score), and a successful project appeared to require the
Discussion
We assessed the cases by assigning quantitative scores to the application of strategies. Merely assigning plus or minus scores to practical strategies is not likely to produce suggestions for their application in other public health cases. The use of strategies needs to be considered from the perspective of the particular context, historical roots, dynamics, and unique persons. The application of a strategy in one case might be contra-productive in another. For example, at the start of the
Conclusion
We conclude that, when administrative, institutional, and individual changes are tuned to each other successful collaboration beyond the initial period is more likely. Coherence between the system levels of the three niches is therefore necessary. Coherence is defined as vertical communication between the actors of the system levels, and horizontal communication between the actors of policy, practice, and research at each system level and sometimes across the system levels. Coherence between
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