Pragmatic Trials; The Mutual Shaping of Research and Primary Health Care Practice: An ethnographic analysis of the role the pragmatic trial fulfils in bridging the science-practice gap

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!

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