Rod Morten Hulvej, Høybye Mette Terp
Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd Floor, 1353 Copenhagen K, Denmark
Center for Planlagt Kirurgi, Silkeborg Hospital, Silkeborg, Denmark.
Health Promot Int. 2016 Sep;31(3):692-703. doi: 10.1093/heapro/dav026. Epub 2015 Apr 26.
Guidelines are increasingly used in an effort to standardize and systematize health practices at the local level and to promote evidence-based practice. The implementation of guidelines frequently faces problems, however, and standardization processes may in general have other outcomes than the ones envisioned by the makers of standards. In 2012, the Danish National Health Authorities introduced a set of health promotion guidelines that were meant to guide the decision making and priority setting of Denmark's 98 local governments. The guidelines provided recommendations for health promotion policies and interventions and were structured according to risk factors such as alcohol, smoking and physical activity. This article examines the process of implementation of the new Danish health promotion guidelines. The article is based on qualitative interviews and participant observation, focusing on the professional practices of health promotion officers in four local governments as well as the field of Danish health promotion more generally. The analysis highlights practices and episodes related to the implementation of the guidelines and takes inspiration from Timmermans and Epstein's sociology of standards and standardization. It remains an open question whether or not the guidelines lead to more standardized policies and interventions, but we suggest that the guidelines promote a risk factor-oriented approach as the dominant frame for knowledge, reasoning, decision making and priority setting in health promotion. We describe this process as a case of epistemic standardization.
指南越来越多地被用于努力使地方层面的卫生实践标准化和系统化，并促进循证实践。然而，指南的实施经常面临问题，而且标准化过程总体上可能产生的结果与标准制定者所设想的不同。2012年，丹麦国家卫生当局出台了一套健康促进指南，旨在指导丹麦98个地方政府的决策和优先事项设定。这些指南为健康促进政策和干预措施提供了建议，并根据酒精、吸烟和体育活动等风险因素进行了构建。本文考察了丹麦新的健康促进指南的实施过程。本文基于定性访谈和参与观察，重点关注四个地方政府中健康促进官员的专业实践以及更广泛的丹麦健康促进领域。分析突出了与指南实施相关的实践和事件，并从蒂默曼斯和爱泼斯坦的标准与标准化社会学中获得灵感。这些指南是否会带来更标准化的政策和干预措施仍是一个悬而未决的问题，但我们认为这些指南促进了一种以风险因素为导向的方法，使其成为健康促进中知识、推理、决策和优先事项设定的主导框架。我们将这一过程描述为一个认知标准化的案例。
