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Introduction: Due to decades of decentralisation of public health policies, local governments have been given increased tobacco control responsibilities across European countries. Previous studies suggest that implementing local tobacco control policies is not without challenges (e.g., lack of resources and enforcement capabilities). This study investigates the policy implementation of both smoke-free environments and smoking cessation support services by local public health professionals in the Netherlands., Method: We interviewed 24 officials of regional public health departments about the barriers and facilitators of implementing local tobacco control policies. Interviews were transcribed, analysed and classified using the Behaviour Change Wheel model (COM-B) comprising of the three components capability, opportunity, and motivation., Results: Personal motivation was an important condition for public health professionals to work on specific subtopics within tobacco control. Smoke-free environments were generally considered most motivating to work on, but also involve practical obstacles such as a lack of enforcement capabilities. Smoking cessation support services were reported to be less attractive to work on, as there are no clear guidelines on what public health professionals could and should do regarding smoking cessation support., Conclusion: Municipalities and local public health departments may contribute to tobacco control by creating smoke-free areas and offering services to help people stop smoking. The national government of the Netherlands could support local governments by providing clearer guidelines on creating smoke-free spaces and on how to improve local smoking cessation support services., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval was received from the ethics review committee of the Faculty of Health, Medicine and Life Sciences of the Maastricht University (FHML-REC/2022/021). Consent for publication: All participants provided written consent for the interview and granted permission for the anonymized use of their data in publication. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Democratic institutions and state-society relations shape governance arrangements and expectations between public and private stakeholders about public health impact. We illustrate this with a comparison between the English Public Health Responsibility Deal (RD) and the Dutch 'All About Health…' (AaH) programme. As manifestations of a Whole-of-Society approach, in which governments, civil society and business take responsibility for the co-production of economic utility and good health, these programmes are two recent collaborative platforms based on voluntary agreements to improve public health. Using a 'most similar cases' design, we conducted a comparative secondary analysis of data from the evaluations of the two programmes. The underlying rationale of both programmes was that voluntary agreements would be better suited than regulation to encourage business and civil society to take more responsibility for improving health. Differences between the two included: expectations of an enforcing versus facilitative role for government; hierarchical versus horizontal coordination; big business versus civil society participants; top-down versus bottom-up formulation of voluntary pledges and progress monitoring for accountability versus for learning and adaptation. Despite the attempt in both programmes to base voluntary commitments on trust, the English 'shadow of hierarchy' and adversarial state-society relationships conditioned non-governmental parties to see the pledges as controlling, quasi-contractual agreements that were only partially lived up to. The Dutch consensual political tradition enabled a civil society-based understanding and gradual acceptance of the pledges as the internalization by partner organizations of public health values within their operations. We conclude that there are institutional limitations to the implementation of generic trust-building and learning-based models of change 'Whole-of-Society' approaches.

Background: Contemporary research should increasingly be carried out in the context of application. Nowotny called this new form of knowledge production Mode-2. In line with Mode-2 knowledge production, the Dutch government in 2006 initiated the so-called Academic Collaborative Centres (ACC) for Public Health. The aim of these ACCs is to build a regional, sustainable knowledge-sharing network to deliver socially robust knowledge. The present study aims to highlight the enabling and constraining push and pull factors of these ACCs in order to assess whether the ACCs are able to build and strengthen a sustainable integrated organizational network between public health policy, practice, and research., Methods: Our empirical analysis builds on a mixed methods design. Quantitative data was derived from records of a survey sent to all 11 ACCs about personnel investments, number and nature of projects, and earning power. Qualitative data was derived from 21 in-depth interviews with stakeholders involved. The interviews were tape-recorded, transcribed, and manually coded as favourable or unfavourable pull or push factors., Results: The extra funding appeared to be the most enabling push factor. The networks secured external grants for about 150 short- and long-term Mode-2 knowledge production projects in the past years. Enabling pull factors improved, especially the number of policy-driven short-term research projects. Exchange agents were able to constructively deal with the constraining push factors, like university's publication pressure and budget limitations. However, the constraining pull factors like local government's involvement and their low demand for scientific evidence were difficult to overcome., Conclusions: A clear improvement of the organizational networks was noticed whereby the ACC's were pushed rather than pulled. Efforts are needed to increase the demand for scientific and socially robust evidence from policymakers and to resolve the regime differences between the research and policy systems, in order to make the bidirectionality of the links sustainable.

In Fiji and other Pacific Island countries, obesity has rapidly increased in the past decade. Therefore, several obesity prevention policies have been developed. Studies show that their development has been hampered by factors within Fiji's policy landscape such as pressure from industry. Since policymakers in the Fijian national government are primarily responsible for the development of obesity policies, it is important to understand their perspectives; we therefore interviewed 15 policymakers from nine Fijian ministries. By applying the "attractor landscape" metaphor from dynamic systems theory, we captured perceived barriers and facilitators in the policy landscape. A poor economic situation, low food self-sufficiency, power inequalities, inappropriate framing of obesity, limited policy evidence, and limited resource sharing hamper obesity policy developments in Fiji. Facilitators include policy entrepreneurs and policy brokers who were active when a window of opportunity opened and who strengthened intersectoral collaboration. Fiji's policy landscape can become more conducive to obesity policies if power inequalities are reduced. In Fiji and other Pacific Island countries, this may be achievable through increased food self-sufficiency, strengthened intersectoral collaboration, and the establishment of an explicit functional focal unit within government to monitor and forecast the health impact of policy changes in non-health sectors.

Objectives: Although 'integrated' public health policies are assumed to be the ideal way to optimize public health, it remains hard to determine how far removed we are from this ideal, since clear operational criteria and defining characteristics are lacking., Methods: A literature review identified gaps in previous operationalizations of integrated public health policies. We searched for an approach that could fill these gaps., Results: We propose the following defining characteristics of an integrated policy: (1) the combination of policies includes an appropriate mix of interventions that optimizes the functioning of the behavioral system, thus ensuring that motivation, capability and opportunity interact in such a way that they promote the preferred (health-promoting) behavior of the target population, and (2) the policies are implemented by the relevant policy sectors from different policy domains., Conclusion: Our criteria should offer added value since they describe pathways in the process towards formulating integrated policy. The aim of introducing our operationalization is to assist policy makers and researchers in identifying truly integrated cases. The Behavior Change Wheel proved to be a useful framework to develop operational criteria to assess the current state of integrated public health policies in practice., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Research findings often fail to find their way into policy and practice, which is assumed to limit the effectiveness of public health policies and programmes. We evaluated to what extent the Academic Collaborative Centre Limburg (ACCL), a Dutch boundary organization linking policy, research and practice, has improved knowledge transfer and exchange between the three domains. We used a mixed-methods approach. First, stakeholders jointly defined the ACCL's programme theory, showing how the ACCL was supposed to achieve its intended effects. Second, we assessed the achievements of the ACCL in terms of knowledge transfer and exchange on the basis of the programme theory. The ACCL was found to provide a platform for interaction between actors from the policy, research and practice domains, facilitated by integrated network structures. The number of collaborative projects and actors involved in the ACCL increased, but actual cross-domain interaction patterns did not really change. Cross-domain knowledge transfer and exchange still require major boundary-spanning efforts by the ACCL programme leader. Boundary organizations do not automatically produce cross-domain interactions. In addition to infrastructural arrangements, cross-domain knowledge transfer and exchange could benefit from additional cultural changes, like adopting a deliberative approach to policy making and applying constructivist research designs., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Childhood obesity is a 'wicked' public health problem that is best tackled by an integrated approach, which is enabled by integrated public health policies. The development and implementation of such policies have in practice proven to be difficult, however, and studying why this is the case requires a tool that may assist local policy-makers and those assisting them. A comprehensive framework that can help to identify options for improvement and to systematically develop solutions may be used to support local policy-makers., Discussion: We propose the 'Behavior Change Ball' as a tool to study the development and implementation of integrated public health policies within local government. Based on the tenets of the 'Behavior Change Wheel' by Michie and colleagues (2011), the proposed conceptual framework distinguishes organizational behaviors of local policy-makers at the strategic, tactical and operational levels, as well as the determinants (motivation, capability, opportunity) required for these behaviors, and interventions and policy categories that can influence them. To illustrate the difficulty of achieving sustained integrated approaches, we use the metaphor of a ball in our framework: the mountainous landscapes surrounding the ball reflect the system's resistance to change (by making it difficult for the ball to roll). We apply this framework to the problem of childhood obesity prevention. The added value provided by the framework lies in its comprehensiveness, theoretical basis, diagnostic and heuristic nature and face validity., Summary: Since integrated public health policies have not been widely developed and implemented in practice, organizational behaviors relevant to the development of these policies remain to be investigated. A conceptual framework that can assist in systematically studying the policy process may facilitate this. Our Behavior Change Ball adds significant value to existing public health policy frameworks by incorporating multiple theoretical perspectives, specifying a set of organizational behaviors and linking the analysis of these behaviors to interventions and policies. We would encourage examination by others of our framework as a tool to explain and guide the development of integrated policies for the prevention of wicked public health problems.

The childhood obesity epidemic can be best tackled by means of an integrated approach, which is enabled by integrated public health policies, or Health in All Policies. Integrated policies are developed through intersectoral collaboration between local government policy makers from health and nonhealth sectors. Such intersectoral collaboration has been proved to be difficult. In this study, we investigated which resources influence intersectoral collaboration. The behavior change wheel framework was used to categorize motivation-, capability-, and opportunity-related resources for intersectoral collaboration. In-depth interviews were held with eight officials representing 10 non-health policy sectors within a local government. Results showed that health and non-health policy sectors did not share policy goals, which decreased motivation for intersectoral collaboration. Awareness of the linkage between health and nonhealth policy sectors was limited, and management was not involved in creating such awareness, which reduced the capability for intersectoral collaboration. Insufficient organizational resources and structures reduced opportunities for intersectoral collaboration. To stimulate intersectoral collaboration to prevent childhood obesity, we recommend that public health professionals should reframe health goals in the terminology of nonhealth policy sectors, that municipal department managers should increase awareness of public health in non-health policy sectors, and that flatter organizational structures should be established.

Background: Joining the domains of practice, research and policy is an important aspect of boosting the quality performance required to tackle complex public health problems. "Joining domains" implies a departure from the linear and technocratic knowledge-translation approach. Integrating the practice, research and policy triangle means knowing its elements, appreciating the barriers, identifying possible cooperation strategies and studying strategy effectiveness under specified conditions.This article examines the dynamic process of developing an Academic Collaborative Centre for Public Health in the Netherlands, with the objective of achieving that the three domains of policy, practice and research become working partners on an equal footing., Method: An interpretative hermeneutic approach was used to interpret the phenomenon of collaboration at the nexus between the three domains. The project was explicitly grounded in current organizational culture and routines, applied to nexus action. In the process of examination, we used both quantitative (e.g. records) and qualitative data (e.g., interviews and observations). The data were interpreted using the Actor-Network, Institutional Re-Design and Blurring the Boundaries theories., Results: Results show commitment at strategic level. At the tactical level, however, managers were inclined to prioritize daily routine, while the policy domain remained absent. At the operational level, practitioners learned to do PhD research in real-life practice and researchers became acquainted with problems of practice and policy, resulting in new research initiatives., Conclusion: We conclude that working at the nexus is an ongoing process of formation and reformation. Strategies based on Institutional Re-Design theories in particular might help to more actively stimulate managers' involvement to establish mutually supportive networks.

The Dutch government encourages municipalities to develop 'Health in All Policies' (HiAP). The development of such a policy requires inter-sectoral collaboration, however municipalities show little initiative in this regard. Operating in an advisory role, the regional Public Health Service (PHS) has supported municipalities in South-Limburg in setting up inter-sectoral collaboration. A coaching program for municipal stakeholders was developed and implemented to improve HiAP, using obesity as an example. To determine the effectiveness of this coaching program, civil servants, managers and municipal councilors were invited to fill in an Internet questionnaire prior to and at the completion of the program. By means of a log-book all activities were registered in coached municipalities and in-depth interviews were held with municipal managers. Outcomes were scored depending on the stage of HiAP proposals. Six of the nine coached municipalities showed concrete outcomes in terms of HiAP proposals. The results show that more support and involvement at each system level stimulates the development of HiAP. The program contributed positively to the implementation of HiAP interventions targeting obesity. The pretest results for coached municipalities were better compared to non-coached municipalities. However, after 30 months of coaching this positive starting position faded away. We recommend that the municipal management become more involved in the development of HiAP and advise the PHS to increasingly demonstrate their expertise. Here lies a challenge for municipalities and their regional PHS., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Experts stress the need to bring the childhood obesity epidemic under control by means of an integrated approach. The implementation of such an approach requires the development of integrated enabling policies on public health by local governments. A prerequisite for developing such integrated public health policies is intersectoral collaboration. Since the development of integrated policies is still in its early stages, this study aimed to answer the following research question: "What interventions can promote intersectoral collaboration and the development of integrated health policies for the prevention of childhood obesity?" Data were collected through a literature search and observations of and interviews with stakeholders. Based on a theoretical framework, we categorized potential interventions that could optimize an integrated approach regarding children's physical activity and diet. The intervention categories included education, persuasion, incentivization, coercion, training, restriction, environmental restructuring, modeling, and enablement.

Objective: The collaboration between policy, practice, and research in local public health was studied in a multiple case study. The assumption is that collaboration will result in more solid evidence and higher quality standards in public health., Methods: First, collaboration barriers were studied by analysing the work cycles of the three domains, which are considered to operate as niches. Actors at the administrative, institutional, and individual levels were identified. Theories that describe processes of the convergence of the three niches through practical strategies were sought. Finally, the application of the practical strategies in six cases was evaluated., Results: When administrative, institutional, and individual changes develop in a similar fashion and in parallel with each other, the likelihood of successful collaboration that goes beyond the initial period is greater. The findings suggest that organisational development (OD) strategies that address collaboration at the institutional level make a relatively strong contribution., Conclusions: Top level consultations just after local elections, investments in OD strategies and a new kind of accountability in public health are recommended. The assumption that successful collaboration contributes to enhanced effectiveness, efficiency, and efficacy of public health could not yet be unequivocally confirmed.

INTRODUCTION Due to a continuing international trend of decentralization of public health policies, local governments are given an increasingly important role in tobacco control. The process of developing local-level tobacco control policies is an underexplored topic. This study uses grant applications as a data source to gain insight into the planning, development and proposed implementation of local tobacco control policies by regional public health departments in the Netherlands. METHODS Grant applications of 24 regional public health departments were analyzed using the second stage of the rational policy cycle, a four-stages policy model about the decisions made by local policy makers during the policy process. We coded the applications with open and axial coding. RESULTS Public health departments formulated four main goals for tobacco control: adding tobacco control policies to existing local policy documents, creating smokefree (child) environments, developing and improving access to smoking cessation care, and participating in media campaigns. Public health departments often specify tobacco control aims and involve partners in reaching these aims. However, the grant applications lacked information about implementing these tobacco control policies. CONCLUSIONS The information on implementation strategies and process evaluation, as well as the (evidence-based) legitimation for the policy choices, needs improvement. Under the current conditions, which include the brief explanation the departments received, an unclear mandate, insufficient funding, and local restricting factors such as time and knowledge, significant contributions to tobacco control policy cannot be expected from local governments. [ABSTRACT FROM AUTHOR]

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Background: Public health includes policy, practice and research but to sufficiently connect academic research, practice and public health policy appears to be difficult. Collaboration between policy, practice and research is imperative to obtaining more solid evidence in public health. However, the three domains do not easily work together because they emanate from three more or less independent 'niches'.Work cycles of each niche have the same successive steps: problem recognition, approach formulation, implementation, and evaluation, but are differently worked out. So far, the research has focused on agenda-setting which belongs to the first step, as expressed by Kingdon, and on the use of academic knowledge in policy makers' decision-making processes which belongs to the fourth step, as elaborated by Weiss. In addition, there are more steps in the policy-making process where exchange is needed.Method: A qualitative descriptive research was conducted by literature search. We analyzed the four steps of the policy, practice and research work cycles. Next, we interpreted the main conflicting aspects as disconnections for each step.Results: There are some conspicuous differences that strengthen the niche character of each domain and hamper integration and collaboration. Disconnections ranged from formulating priorities in problem statements to power roles, appraisal of evidence, work attitudes, work pace, transparency of goals, evaluation and continuation strategies and public accountability. Creating awareness of these disconnections may result in more compatibility between researchers, policy makers and practitioners.Conclusion: We provide an analysis that can be used by public health services-related researchers, practitioners and policy makers to be aware of the risk for disconnections. A synthesis of the social, practical and scientific relevance of public health problems should be the starting point for a dialogue that seeks to establish a joint approach. To overcome the above mentioned disconnections, face-to-face encounters consistently emerge as the most efficient way to transfer knowledge, achieve higher quality and acknowledge mutual dependence. We recommend practice and policy based research networks to establish strong links between researchers, policy makers and practitioners to improve public health. [ABSTRACT FROM AUTHOR]