http://repub.eur.nl/res/aut/13610/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/31742/ 2012-03-02T00:00:00Z This doctoral thesis evolved around the issue of how to evaluate the effectiveness of health promotion and prevention such that it matches the criteria for sound scientific research and at the same time produces knowledge that can more easily be embedded in routine medical practice. In other words, this thesis concerned the issue of how to bridge the science-practice gap in complex public health settings. In this doctoral thesis one example of an evaluation methodology has been analysed that tried to accomplish this. An ethnographic case study has been performed of the Quattro Study: a pragmatic trial for evaluating the effectiveness of multidisciplinary patient care teams for the prevention of cardiovascular risk in primary health care practice in deprived neighbourhoods in Rotterdam and The Hague in the Netherlands. The ethnographic findings show how the pragmatic trial methodology and its instruments help to overcome the dichotomy between routine medical practice and scientific evaluation. This doctoral thesis allows for a fundamental rethinking of the pragmatic trial methodology not as a new mode of evaluating complex interventions in prevention and health promotion, but as an infrastructure for pragmatically embedding innovation(s) in primary health care. Building on the performativity of the infrastructure that is the pragmatic trial, such embedding of innovations can be more fruitfully explored and tested. The problem with the pragmatic trial methodology is not that it is pragmatic. The problem is that it is not pragmatic enough! http://repub.eur.nl/res/pub/21494/ 2010-11-11T00:00:00Z Abstract In prevention and health promotion interventions, screening methods and risk profile assessments are often used as tools for establishing the interventions' effectiveness, for the selection and determination of the health status of participants. The role these instruments fulfil in the creation of effectiveness and the effects these instruments have themselves remain unexplored. In this paper, we have analysed the role screening methods and risk profile assessments fulfil as part of prevention and health promotion programmes in the selection, enrolment and participation of participants. Our analysis showed, that screening methods and health risk assessments create effects as they objectify health risks and/or the health status of individuals, i.e., they select the individuals 'at risk' and indicate the lifestyle modifications these people are required to make in order to improve their health. Yet, these instruments also reduce the group of participants thereby decreasing the possible effect of interventions, as they provide the legitimisation for people to make choices to whether they enrol or not and what lifestyle changes they incorporate into their lives. In other words, they present a space of interaction, in which agency is distributed across the practice nurses, the participants and the instruments. Decisions were not just made upon the projection of the outcomes of these instruments; decisions that were made by both the patients and practice nurses were the resultant of their opinions on these outcomes that were formed in interaction with the instruments. http://repub.eur.nl/res/pub/19404/ 2009-01-01T00:00:00Z BACKGROUND: In recent years, a trend in the use of tailor-made approaches and pragmatic trial methodology for evaluating effectiveness has been visible in programs ranging from large-scale national health prevention campaigns to community-based initiatives. Qualitative research is used more often for tailoring interventions towards communities and/or local care practices. This article systematically reviews the contribution of qualitative research in developing tailor-made community-based interventions in primary care evaluated by means of the pragmatic trial methodology. METHODS: A systematic search of Pubmed/Medline and Embase revealed 33 articles. Using a literature mapping process, the articles were arranged according to the development phases identified in the MRC framework for the development of complex interventions to improve health. RESULTS: The review showed qualitative research is mainly used to provide insight into the contextual circumstances of the interventions' implementation, delivery and evaluation. To a lesser extent, qualitative research findings are used for tailoring and improving the design of the interventions for a better fit with daily primary care practice. Moreover, most qualitative findings are used for tailoring the interventions' contextual circumstances so that the interventions are performed in practice as planned, rather than adjusted to local circumstances. CONCLUSIONS: Pragmatic trials seem to be oxymoronic. Although the pragmatic trial methodology establishes the effectiveness of interventions under natural, non-experimental conditions, no pragmatic fit is allowed. Qualitative research's contribution to the development of tailor-made community-based interventions lies in providing ongoing evaluations of the dilemmas faced in pragmatic trials and allowing for the development of true tailor-made interventions http://repub.eur.nl/res/pub/23191/ 2009-01-01T00:00:00Z Dit artikel gaat over de spanning tussen ‘betrokkenheid’ en ‘distantie’ verbonden aan participerende observatie binnen een onderzoeksproject dat wordt uitgevoerd door collega- onderzoekers. http://repub.eur.nl/res/pub/36873/ 2007-09-06T00:00:00Z Background. Tailor-made approaches enable the uptake of interventions as they are seen as a way to overcome the incompatibility of general interventions with local knowledge about the organisation of routine medical practice and the relationship between the patients and the professionals in practice. Our case is the Quattro project which is a prevention programme for cardiovascular diseases in high-risk patients in primary health care centres in deprived neighbourhoods. This programme was implemented as a pragmatic trial and foresaw the importance of local knowledge in primary health care and internal, or locally made, guidelines. The aim of this paper is to show how this prevention programme, which could be tailored to routine care, was implemented in primary care. Methods. An ethnographic design was used for this study. We observed and interviewed the researchers and the practice nurses. All the research documents, observations and transcribed interviews were analysed thematically. Results. Our ethnographic process evaluation showed that the opportunity of tailoring intervention procedures to routine care in a pragmatic trial setting did not result in a well-organised and well-implemented prevention programme. In fact, the lack of standard protocols hindered the implementation of the intervention. Although it was not the purpose of this trial, a guideline was developed. Despite the fact that the developed guideline functioned as a tool, it did not result in the intervention being organised accordingly. However, the guideline did make tailoring the intervention possible. It provided the professionals with the key or the instructions needed to achieve organisational change and transform the existing interprofessional relations. Conclusion. As tailor-made approaches are developed to enable the uptake of interventions in routine practice, they are facilitated by the brokering of tools such as guidelines. In our study, guidelines facilitated organisational change and enabled the transformation of existing interprofessional relations, and thus made tailoring possible. The attractive flexibility of pragmatic trial design in taking account of local practice variations may often be overestimated. http://repub.eur.nl/res/pub/8897/ 2006-01-01T00:00:00Z Background: The aim of this paper is to show how researchers balance between scientific rigour and localisation in conducting pragmatic trial research. Our case is the Quattro Study, a pragmatic trial on the effectiveness of multidisciplinary patient care teams used in primary health care centres in deprived neighbourhoods of two major cities in the Netherlands for intensified secondary prevention of cardiovascular diseases. Methods: For this study an ethnographic design was used. We observed and interviewed the researchers and the practice nurses. All gathered research documents, transcribed observations and interviews were analysed thematically. Results: Conducting a pragmatic trial is a continuous balancing act between meeting methodological demands and implementing a complex intervention in routine primary health care. As an effect, the research design had to be adjusted pragmatically several times and the intervention that was meant to be tailor-made became a rather stringent procedure. Conclusion: A pragmatic trial research is a dynamic process that, in order to be able to assess the validity and reliability of any effects of interventions must also have a continuous process of methodological and practical reflection. Ethnographic analysis, as we show, is therefore of complementary value.