Looking for interaction: quantitative measurement of research utilization by Dutch local health officials.

BACKGROUND: In the Netherlands, local authorities are required by law to develop local health memoranda, based on epidemiological analyses. The purpose of this study was to assess the actual use of these epidemiological reports by municipal health officials and associated factors that affect this use. METHOD: Based on a conceptual framework, we designed a questionnaire in which we operationalized instrumental, conceptual, and symbolic use, the interaction between researchers and local health officials, and four clusters of barriers in this interaction process. We conducted an internet survey among 155 Dutch local health officials representing 35% of all Dutch municipalities. By means of multiple regression analyses, we gained insight into the related factors for each of the three types of research utilization. RESULTS: The results show that local health officials use epidemiological research more often in a conceptual than an instrumental or symbolic way. This can be explained by the complexity of the local policy process which is often linked to policies in other areas, and the various policy actors involved. Conceptual use was statistically associated with a presentation given by the epidemiologist during the policy process, the presence of obstructions regarding the report's accessibility, and the local official's personal belief systems and interests originating from different professional values and responsibilities. Instrumental and symbolic use increased with the involvement of local officials in the research process. CONCLUSIONS: The results of this study provide a partial solution to understanding and influencing research utilization. The quantitative approach underpins earlier qualitative findings on this topic. The outcomes suggest that RPHS epidemiologists can use different strategies to improve research utilization. 'Blurring the boundaries', and the enhancement of interfaces between epidemiologists and local health officials, like direct interactions into each other's work processes, is expected to create better possibilities for optimizing research use.

Utilization of epidemiological research for the development of local public health policy in The Netherlands: a case study approach.

The use of epidemiological research in local health policy development is claimed to be problematic. In three in-depth case studies in Dutch municipalities, we examined the interface between local epidemiological research and local health policy development, and the use of epidemiological reports, published as Local Health Messages (LHMs). The qualitative study design is based on an earlier developed theoretical framework of extended interaction. We collected data about 129 actors, via face-to-face semi-structured interviews, telephone interviews, internet questionnaires, observations, and organizational documents. Local health report development was characterized by multiple interactions between Regional Public Health Service epidemiologists, policy advisors, and local health officials. The LHMs as well as the policy memoranda can be considered as socially constructed. Preliminary interaction helped to manage the expectations of the local health officials and improved a specific type of use of LHMs in the policy process. However, we discovered a lack of use of the LHMs by specific groups of actors within the policy network, which could be explained by factors influencing the actors, such as personal belief systems and values, institutional interests, and contextual factors such as the design of the policy processes. We concluded that the necessity of interactions depends on the frames of references of the potential users and as a consequence it is difficult to give a single solution for improvement of epidemiological research utilization for local health policy. Different interaction mechanisms between researchers and policy actors can be active at the same time and may differ between municipalities. Therefore it becomes important to obtain insight in the policy process and tailor strategically promising ways of interaction.

Knowledge in process? Exploring barriers between epidemiological research and local health policy development.

BACKGROUND: In the Netherlands municipalities are legally required to draw up a Local Health Policy Memorandum every four years. This policy memorandum should be based on (local) epidemiological research as performed by the Regional Health Services. However, it is largely unknown if and in what way epidemiological research is used during local policy development. As part of a larger study on knowledge utilization at the local level in The Netherlands, an analytical framework on the use of epidemiological research in local health policy development in the Netherlands is presented here. METHOD: Based on a literature search and a short inventory on experiences from Regional Health Services, we made a description of existing research utilization models and concepts about research utilization. Subsequently we mapped different barriers in research transmission. RESULTS: The interaction model is regarded as the main explanatory model. It acknowledges the interactive and incremental nature of policy development, which takes place in a context and includes diversity within the groups of researchers and policymakers. This fits well in the dynamic and complex setting of local Dutch health policy.For the conceptual framework we propose a network approach, in which we "extend" the interaction model. We not only focus on the one-to-one relation between an individual researcher and policymaker but include interactions between several actors participating in the research and policy process.In this model interaction between actors in the research and the policy network is expected to improve research utilization. Interaction can obstruct or promote four clusters of barriers between research and policy: expectations, transfer issues, acceptance, and interpretation. These elements of interactions and barriers provide an actual explanation of research utilization. Research utilization itself can be measured on the individual level of actors and on a policy process level. CONCLUSION: The developed framework has added value on existing models on research utilization because it emphasizes on the 'logic' of the context of the research and policy networks. The framework will contribute to a better understanding of the impact of epidemiological research in local health policy development, however further operationalisation of the concepts mentioned in the framework remains necessary.