Kuunders Theo J M, van Bon-Martens Marja J H, van de Goor Ien A M, Paulussen Theo G W M, van Oers Hans A M
Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, LE Tilburg, The Netherlands.
Regional Health Service, 'GGD Hart voor Brabant', 's-Hertogenbosch, The Netherlands.
Health Promot Int. 2018 Aug 1;33(4):635-647. doi: 10.1093/heapro/dax003.
To develop a targeted implementation strategy for a municipal health policy guideline, implementation targets of two guideline users [Regional Health Services (RHSs)] and guideline developers of leading national health institutes were made explicit. Therefore, characteristics of successful implementation of the guideline were identified. Differences and similarities in perceptions of these characteristics between RHSs and developers were explored. Separate concept mapping procedures were executed in two RHSs, one with representatives from partner local health organizations and municipalities, the second with RHS members only. A third map was conducted with the developers of the guideline. All mapping procedures followed the same design of generating statements up to interpretation of results with participants. Concept mapping, as a practical implementation tool, will be discussed in the context of international research literature on guideline implementation in public health. Guideline developers consider implementation successful when substantive components (health issues) of the guidelines, content are visible in local policy practice. RHSs, local organizations and municipalities view the implementation process itself within and between organizations as more relevant, and state that usability of the guideline for municipal policy and commitment by officials and municipal managers are critical targets for successful implementation. Between the RHSs, differences in implementation targets were smaller than between RHSs and guideline developers. For successful implementation, RHSs tend to focus on process targets while developers focus more on the thematic contents of the guideline. Implications of these different orientations for implementation strategies are dealt with in the discussion.
为制定一项市级卫生政策指南的针对性实施策略，明确了该指南的两类使用者[区域卫生服务机构（RHSs）]以及国家主要卫生机构的指南制定者的实施目标。因此，确定了该指南成功实施的特征。探讨了RHSs与指南制定者在对这些特征的认知上的异同。在两个RHSs中分别执行了单独的概念映射程序，一个由来自合作的当地卫生组织和市政当局的代表参与，另一个仅由RHS成员参与。与指南制定者进行了第三个映射。所有映射程序都遵循相同的设计，即从生成陈述到与参与者一起解释结果。概念映射作为一种实用的实施工具，将在关于公共卫生指南实施的国际研究文献背景下进行讨论。指南制定者认为，当指南的实质性内容（健康问题）在地方政策实践中可见时，实施就是成功的。RHSs、地方组织和市政当局认为组织内部和组织之间的实施过程本身更为重要，并指出指南对市政政策的可用性以及官员和市政管理人员的承诺是成功实施的关键目标。在RHSs之间，实施目标的差异小于RHSs与指南制定者之间的差异。为实现成功实施，RHSs倾向于关注过程目标，而指南制定者则更关注指南的主题内容。讨论中涉及了这些不同方向对实施策略的影响。
