J.A.M. van Oers

A lifestyle intervention to reduce Type 2 diabetes risk in Dutch primary care: 2.5-year results of a randomized controlled trial

Diabet. Med. 29, e223–e231 (2012)

Concept mapping as a promising method to bring practice into science.

OBJECTIVE Concept mapping is a method for developing a conceptual framework of a complex topic for use as a guide to evaluation or planning. In concept mapping, thoughts and ideas are represented in the form of a picture or map, the content of which is determined by a group of stakeholders. This study aimed to explore the suitability of this method as a tool to integrate practical knowledge with scientific knowledge in order to improve theory development as a sound basis for practical decision-making. METHOD Following a short introduction to the method of concept mapping, five Dutch studies, serving different purposes and fields in public health, will be described. The aim of these studies was: to construct a theoretical framework for good regional public health reporting; to design an implementation strategy for a guideline for integral local health policy; to guide the evaluation of a local integral approach of overweight and obesity in youth; to guide the construction of a questionnaire to measure the quality of postdisaster psychosocial care; and to conceptualize an integral base for formulation of ambitions and targets for the new youth healthcare programme of a regional health service. RESULTS The studies showed that concept mapping is a way to integrate practical and scientific knowledge with careful selection of participants that represent the different perspectives. Theory development can be improved through concept mapping; not by formulating new theories, but by highlighting the key issues and defining perceived relationships between topics. In four of the five studies, the resulting concept map was received as a sound basis for practical decision-making. CONCLUSIONS Concept mapping is a valuable method for evidence-based public health policy, and a powerful instrument for facilitating dialogue, coherence and collaboration between researchers, practitioners, policy makers and the public. Development of public health theory was realized by a step-by-step approach, considering both scientific and practical knowledge. However, the external validity of the concept maps in place and time is of importance.

Schools as smoke-free zones? Barriers and facilitators to the adoption of outdoor school ground smoking bans at secondary schools

BackgroundWhereas smoking bans inside secondary school buildings are relatively widespread, a smoking ban for the outdoor school grounds is less common. Therefore, this study investigates why many secondary schools fail to adopt an outdoor school ground smoking ban. The aim is to elucidate the perceived barriers and facilitators of stakeholders at schools without an outdoor school ground smoking ban.MethodsQualitative data were obtained from 60 respondents of 15 secondary schools. Semi-structured interviews were held with various key stakeholders and a thematic approach was used for analysis of the transcripts.ResultsThe perceived barriers and facilitators of the stakeholders fell into four categories: 1) socio-political characteristics (legislation and social norm), 2) school characteristics (policy, decision process, enforcement, resources, workforce conditions, communication and collaboration), 3) individual characteristics (support, knowledge, and target group), and 4) smoking ban characteristics (environmental factors, guideline recommendations, outcome expectations, and evidence).ConclusionsThese findings highlight the importance of legislation for outdoor smoking bans. Moreover, collaboration, communication and involving stakeholders during an early stage of the process should be stimulated, as this might increase adoption. These results can be applied in future studies on outdoor tobacco control policies; moreover, they may facilitate tobacco control initiatives leading to more smoke-free environments to further protect youth from the harmful effects of tobacco.

Evaluatie van de regionale Volksgezondheid Toekomst Verkenning in twee Brabantse regio’s

SamenvattingIn de regio’s van de GGD’en Hart voor Brabant en West-Brabant is een regionale VTV ontwikkeld. Deze regionale VTV bestaat uit drie onderdelen: een Samenvattend rapport per GGD-regio, een rapportage met Kernboodschappen voor lokaal beleid per gemeente en de website Regionaal Kompas Volksgezondheid (www.regionaalkompas.nl). De regionale VTV is vanuit de Academische Werkplaats Openbare Gezondheidszorg Tilburg geëvalueerd onder betrokkenen en (beoogde) gebruikers door middel van vragenlijsten, (groeps)interviews en een documentenanalyse. Dit artikel beschrijft de resultaten van deze evaluatie. De bekendheid en het gebruik van de regionale VTV bleek groot. De bruikbaarheid van de regionale VTV, in termen van inhoud, vormgeving, relevantie, samenhang tussen de producten en meerwaarde ten opzichte van bestaande informatie, werd in het algemeen positief beoordeeld. Als belangrijke randvoorwaarden kwamen vooral naar voren: een goede timing in relatie tot de lokale beleidscyclus, goede en structurele communicatie over voortgang, planning en besluitvorming, en vroegtijdige betrokkenheid van gemeenten. De succesfactoren en aanbevelingen die voortvloeien uit de evaluatiestudie worden zowel gebruikt bij de verdere ontwikkeling van de volgende regionale VTV in beide regio’s als voor de ontwikkeling van een generiek model voor een regionale VTV.AbstractEvaluation of the regional Public Health Status and Forecasts Report in two Dutch regionsA regional Public Health Status and Forecasts Report (PHSF) has been developed in the working areas of the Regional Health Services (RHS) ‘Hart voor Brabant’ and ‘West-Brabant’, consisting of three products: a Summary report for each RHS-region, a report with Key messages for local health policy for each municipality and a website ‘Regional Health Compass’ (www.regionaalkompas.nl). This article describes the results of the Academic Collaborative Centre Public Health Tilburg’s evaluation of these regional PHSFs, among staff concerned and (intended) users, by means of questionnaires, (group) interviews and document analysis. The regional PHSF proved to be well known and widely used. Its usefulness, defined by content, design, relevance, coherence between the three products, and added value compared to existing information sources, was judged positively. A good timing in relation to the local policy cycle, good and structural communication about progress, planning and decision-making, and early involvement of local authorities were assessed as important conditions. Success factors and recommendations arisen from this evaluation study will be used in the further development of the next regional PHSF in both regions, as well as for the development of a generic model for a regional PHSF.

Sustainability of outdoor school ground smoking bans at secondary schools: a mixed-method study

Abstract Background Although increasing numbers of countries are implementing outdoor school ground smoking bans at secondary schools, less attention is paid to the post-implementation period even though sustainability of a policy is essential for long-term effectiveness. Therefore, this study assesses the level of sustainability and examines perceived barriers/facilitators related to the sustainability of an outdoor school ground smoking ban at secondary schools. Methods A mixed-method design was used with a sequential explanatory approach. In phase I, 438 online surveys were conducted and in phase II, 15 semi-structured interviews were obtained from directors of relevant schools. ANOVA (phase I) and a thematic approach (phase II) were used to analyze data. Results Level of sustainability of an outdoor school ground smoking ban was high at the 48% Dutch schools with an outdoor smoking ban. Furthermore, school size was significantly associated with sustainability. The perceived barriers/facilitators fell into three categories: (i) smoking ban implementation factors (side-effects, enforcement, communication, guidelines and collaboration), (ii) school factors (physical environment, school culture, education type and school policy) and (iii) community environment factors (legislation and social environment). Conclusions Internationally, the spread of outdoor school ground smoking bans could be further promoted. Once implemented, the ban has become ‘normal’ practice and investments tend to endure. Moreover, involvement of all staff is important for sustainability as they function as role models, have an interrelationship with students, and share responsibility for enforcement. These findings are promising for the sustainability of future tobacco control initiatives to further protect against the morbidity/mortality associated with smoking.

Integration between practice, policy and research in public health: results of a multiple case study

IssueOne explanation put forward for women’s higher sickness absence, is they often have the main responsibility for the domestic work. Studies on the association between health and ‘double burden’ ...

Developing a policy game intervention to enhance collaboration in public health policymaking in three European countries

BackgroundOne of the key elements to enhance the uptake of evidence in public health policies is stimulating cross-sector collaboration. An intervention stimulating collaboration is a policy game. The aim of this study was to describe the design and methods of the development process of the policy game ‘In2Action’ within a real-life setting of public health policymaking networks in the Netherlands, Denmark and Romania.MethodsThe development of the policy game intervention consisted of three phases, pre intervention, designing the game intervention and tailoring the intervention.ResultsIn2Action was developed as a role-play game of one day, with main focus to develop in collaboration a cross-sector implementation plan based on the approved strategic local public health policy.ConclusionsThis study introduced an innovative intervention for public health policymaking. It described the design and development of the generic frame of the In2Action game focusing on enhancing collaboration in local public health policymaking networks. By keeping the game generic, it became suitable for each of the three country cases with only minor changes. The generic frame of the game is expected to be generalizable for other European countries to stimulate interaction and collaboration in the policy process.

Burgerparticipatie bij preventie: durven loslaten

Van oudsher is preventie het terrein waar de overheid de scepter zwaait. De grootste gezondheidswinst is in het verleden geboekt door landelijk ingevoerdepreventieve maatregelen, onder meer op het gebied van riolering, drinkwatervoorziening, huisvesting, vaccinatie en arbeidsomstandigheden. Echter, tijden zijn veranderd. De grootste uitdaging voor de publieke gezondheidszorg is niet langer uitsluitend gericht op het verhogen van de levensverwachting, maar ook op het verbeteren van de kwaliteit van leven bij ziekte, en het verkleinen van gezondheidsverschillen. De focus is verschoven van het grote collectiefnaar kleinere risicogroepen en het individu. Anno 2013 bestempelen we bemoeienis van de overheid met een ongezonde leefwijze, al gauw als betutteling.

Afstemming regionale VTV en VAAM

Een betere afstemming tussen de informatievoorziening in de openbare gezondheidszorg en de eerste lijn zou een belangrijke gemeenschappelijke basis kunnen bieden voor het verbinden van de openbare en de curatieve gezondheidszorg. Belangrijke instrumenten in de informatievoorziening op lokaal niveau zijn de regionale Volksgezondheid Toekomst Verkenning (VTV) voor de openbare gezondheidszorg en de Vraag Aanbod Analyse Monitor (VAAM) voor de eerste lijn. In deze haalbaarheidsstudie onderzochten we in hoeverre we de informatievoorziening van deze instrumenten beter op elkaar kunnen laten aansluiten. De methode van onderzoek bestaat voor beide instrumenten uit een aantal overeenkomstige fases (inventarisatie, selectie, analyse en uitwerking) waarbij de beoogde gebruikers van beide instrumenten werden betrokken om de relevantie voor het doel van het instrument aan te geven en te bewaken. De resultaten laten zien dat afstemming van de informatievoorziening in de VAAM en de regionale VTV wenselijk wordt gevonden, maar op dit moment nog maar beperkt mogelijk is. De regionale VTV kan al wel worden aangevuld met VAAM gegevens over vraag en aanbod van huisartsenzorg: voor gemeenten de belangrijkste vorm van eerstelijnszorg. De VAAM kan worden uitgebreid met gegevens over gezondheid en preventie uit de regionale gezondheidsenquêtes: een van de belangrijkste bronnen van de regionale VTV. De voorspelling van de verwachte zorgvraag in de VAAM wordt hiermee echter niet verbeterd. Voor het verbinden van de openbare en de eerstelijnszorg blijkt het vooral belangrijk om te investeren in de dialoog tussen gemeenten en eerste lijn.AbstractBringing the regional Public Health Status and Forecasts report (PHSF) and the Supply and Demand Analysis Monitor (VAAM) into alignmentFeasibility study into cohesive information provision for health and care at the regional and local levelsImproved alignment between the provision of information in public health and in primary healthcare could provide an important common basis for linking up public and curative healthcare. Important instruments for providing information at local level are the Public Health Status and Forecasts report (PHSF) for public health, and the Supply and Demand Analysis Monitor (VAAM) for primary healthcare. In this feasibility study, we investigated how we could better align the information provided by these two instruments. For both instruments, the research approach consisted of a number of common phases (inventory, selection, analysis, and working out) in which the intended users of both instruments were involved so as to indicate and ensure the relevance of the instrument to the objective of the instrument. The results show that, while alignment between the information provided in the VAAM and the regional PHSF is considered to be desirable, at present this is possible only to a limited extent. It is already possible to supplement the regional PHSF with VAAM data on supply and demand for GP care (for Local Authorities, the most important form of primary healthcare). Similarly, the VAAM can be extended with data on health and prevention from the regional health surveys (one of the most important sources for the regional PHSF). However, the VAAM forecasts of expected care demand cannot be improved in this way. To link up public health and primary healthcare at local level it is above all important to invest in the dialogue between Local Authorities and primary healthcare.

Kansen en uitdagingen voor de implementatie van een leefstijlinterventie voor de preventie van type 2 diabetes in de huisartsenpraktijk

SamenvattingDoordat (financiële) middelen in de dagelijkse zorgpraktijk vaak beperkt zijn vergeleken met studies in een onderzoekssetting, vormt de vertaling van bewezen effectieve interventies naar de reguliere zorg een uitdaging. In deze studie evalueerden we daarom de implementatie van de APHRODITE-leefstijlinterventie voor de preventie van type 2 diabetes in de Nederlandse huisartsenpraktijk.