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Abstract: 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. [Copyright &y& Elsevier]

Abstract: Practitioners and academic researchers increasingly look to evaluation of health impact assessment (HIA) to improve its practice, its efficiency and its legitimacy. Evaluation is also used to account to policy-makers, who express doubts that the benefits of HIA justify its costs. Until recently evaluation of HIA focused on instrument design and procedures but now the focus needs to shift to analysis of the interaction of HIA and decision-making. Multiple case studies have been applied to identify the conditions in which HIA produces the desired benefits. These studies used analytical concepts derived from the literature on evaluation, knowledge utilization, science of sociology and knowledge management. This paper describes a case study in which the strategic motives of the decision-makers affected the impact of an HIA. This HIA comprised of a quantitative environmental model ‘City & Environment’ that was used to assess environmental health impacts of an urban reconstruction plan in a Dutch city. The evaluation of the HIA shows that the decision to follow the recommendations of the HIA was part of a damage control strategy. The more HIA goals deviate from the policy problem and the less HIA is embedded in institutional procedures, then the more HIA impact will be subject to strategic decision-making behaviour. Appropriate cognitive and social strategies are needed to avoid ‘negative learning’ in those the HIA seeks to influence. [Copyright &y& Elsevier]

Abstract: If HIA is to be an effective instrument for optimising health interests in the policy making process it has to recognise the different contests in which policy is made and the relevance of both technical rationality and political rationality. Policy making may adopt a rational perspective in which there is a systematic and orderly progression from problem formulation to solution or a network perspective in which there are multiple interdependencies, extensive negotiation and compromise, and the steps from problem to formulation are not followed sequentially or in any particular order. Policy problems may be simple with clear causal pathways and responsibilities or complex with unclear causal pathways and disputed responsibilities. Network analysis is required to show which stakeholders are involved, their support for health issues and the degree of consensus. From this analysis three models of HIA emerge. The first is the phases model which is fitted to simple problems and a rational perspective of policymaking. This model involves following structured steps. The second model is the rounds (Echternach) model that is fitted to complex problems and a network perspective of policymaking. This model is dynamic and concentrates on network solutions taking these steps in no particular order. The final model is the “garbage can” model fitted to contexts which combine simple and complex problems. In this model HIA functions as a problem solver and signpost keeping all possible solutions and stakeholders in play and allowing solutions to emerge over time. HIA models should be the beginning rather than the conclusion of discussion the worlds of HIA and policymaking. [Copyright &y& Elsevier]

Like any policy-relevant research, HIA faces the risk of not being used by decisions-makers. This article addresses the questions: “How do policy decisions come about?” and “How does this affect HIA?” Current literature in political-administrative sciences identifies three ways for decision-making: rational, incremental and mixed model. These models define the relationship between the policy process at stake and the HIA. In incremental or mixed model decision-making, use of HIA evidence by policy-makers is heavily dependent on their values in the context, which may result in conceptual utilization or may extend to strategic utilization. In rational decision-making, HIA provides information independent from the context, which results in instrumental utilization. HIA practitioners need to optimise utilization and produce an appropriate HIA by mapping the policy process. They can do this by asking the questions ‘What? How? Who? and What context? and by maintaining continuous communication with the decision-makers. An appropriate HIA is policy-, time- and place-specific: reflecting the decision-making of the policy at stake. Furthermore, HIA concerns two policy fields with two different contexts and, in some cases, two different decision-making models. The administrative requirements for an appropriate HIA need further exploration. [Copyright &y& Elsevier]

OBJECTIVE: To explore patients' experiences with online health communities in which both physicians and patients participate (i.e. patient-to-doctor or 'P2D' communities). METHODS: A qualitative content analysis was conducted, based on observations in five P2D communities ranging from 8 to 21 months, and semi-structured interviews (N=17) with patients. RESULTS: Patients consider information from physicians and peers as two distinct sources, value both sources differently and appreciate accessing both in the same web space. According to respondents, physicians can provide 'reliable' and evidence-based information, while patients add experience-based information. Patients use this information for multiple purposes, including being informed about scientific research and personal reflection. CONCLUSION: Patients find P2D communities beneficial because they help patients to collect information from both medical experts and experiential experts in one place. PRACTICE IMPLICATIONS: Patients use P2D communities to perform medical, emotional and lifestyle activities. The presence of physicians in P2D communities may inadvertently suggest that the quality of information used for the activities, is controlled. When information is not officially being checked, this should be stated explicitly on the website and supplemented with a statement that information is only indicative and that patients should at all times contact their own physicians. [ABSTRACT FROM AUTHOR]