Understanding the impact of area-based interventions on area safety in deprived areas: realist evaluation of a neighbour nuisance intervention in Arnhem, the Netherlands

Background: Area-based health inequalities may partly be explained by higher levels of area disorder in deprived areas. Area disorder may cause safety concerns and hence impair health. This study assessed how, for whom and in what conditions the intervention Meeting for Care and Nuisance (MCN) had an impact on neighbour nuisance and area safety in four deprived districts in Arnhem, the Netherlands.Methods: Realist evaluation methodology was applied to uncover how, for whom, and under what conditions MCN was expected to and actually produced change. Expected change was based on action plans and scientific theories. Actual change was based on progress reports, media articles, interviews with district managers, and quantitative surveys.Results: Three levels of impact were distinguished. At the organisational level, partly as expected, MCN’s coordinated partnership strategy enabled role alignment, communication, and leadership. This resulted in a more efficient approach of nuisance households. At the level of nuisance households, as expected, MCN’s joint assistance and enforcement strategy removed many of the underlying reasons for nuisance. This resulted in less neighbour nuisance. At the district level, perceptions of social control and area safety improved only in one district. Key conditions for change included a wider safety approach, dense population, and central location of the district within the city.Conclusions: This realist evaluation provided insight into the mechanisms by which a complex area-based intervention was able to reduce neighbour nuisance in deprived areas. Depending on wider conditions, such a reduction in neighbour nuisance may or may not lead to improved perceptions of area safety at the district level

Evaluation of the theory-based Quality Improvement in Physical Therapy (QUIP) programme: a one-group, pre-test post-test pilot study

BACKGROUND: Guideline adherence in physical therapy is far from optimal, which has consequences for the effectiveness and efficiency of physical therapy care. Programmes to enhance guideline adherence have, so far, been relatively ineffective. We systematically developed a theory-based Quality Improvement in Physical Therapy (QUIP) programme aimed at the individual performance level (practicing physiotherapists; PTs) and the practice organization level (practice quality manager; PQM). The aim of the study was to pilot test the multilevel QUIP programme’s effectiveness and the fidelity, acceptability and feasibility of its implementation. METHODS: A one-group, pre-test, post-test pilot study (N = 8 practices; N = 32 PTs, 8 of whom were also PQMs) done between September and December 2009. Guideline adherence was measured using clinical vignettes that addressed 12 quality indicators reflecting the guidelines’ main recommendations. Determinants of adherence were measured using quantitative methods (questionnaires). Delivery of the programme and management changes were assessed using qualitative methods (observations, group interviews, and document analyses). Changes in adherence and determinants were tested in the paired samples T-tests and expressed in effect sizes (Cohen’s d). RESULTS: Overall adherence did not change (3.1%; p = .138). Adherence to three quality indicators improved (8%, 24%, 43%; .000 ≤ p ≤ .023). Adherence to one quality indicator decreased (−15.7%; p = .004). Scores on various determinants of individual performance improved and favourable changes at practice organizational level were observed. Improvements were associated with the programme’s multilevel approach, collective goal setting, and the application of self-regulation; unfavourable findings with programme deficits. The one-group pre-test post-test design limits the internal validity of the study, the self-selected sample its external validity. CONCLUSIONS: The QUIP programme has the potential to change physical therapy practice but needs considerable revision to induce the ongoing quality improvement process that is required to optimize overall guideline adherence. To assess its value, the programme needs to be tested in a randomized controlled trial

Smoking Cessation in Lower Socioeconomic Groups: Adaptation and Pilot Test of a Rolling Group Intervention

Background. Socioeconomic inequalities in smoking rates persist and tend to increase, as evidence-based smoking cessation programs are insufficiently accessible and appropriate for lower socioeconomic status (SES) smokers to achieve long-term abstinence. Our study is aimed at systematically adapting and pilot testing a smoking cessation intervention for this specific target group. Methods. First, we conducted a needs assessment, including a literature review and interviews with lower SES smokers and professional stakeholders. Next, we selected candidate interventions for adaptation and decided which components needed to be adopted, adapted, or newly developed. We used Intervention Mapping to select effective methods and practical strategies and to build a coherent smoking cessation program. Finally, we pilot tested the adapted intervention to assess its potential effectiveness and its acceptability for lower SES smokers. Results. The core of the adapted rolling group intervention was the evidence-based combination of behavioral support and pharmacotherapy. The intervention offered both group and individual support. It was open to smokers, smokers who had quit, and quitters who had relapsed. The professional-led group meetings had a fixed structure. Themes addressed included quitting-related coping skills and health-related and poverty-related issues. Methods applied were role modeling, practical learning, reinforcement, and positive feedback. In the pilot test, half of the 22 lower SES smokers successfully quit smoking. The intervention allowed them to "quit at their own pace"and to continue despite a possible relapse. Participants appraised the opportunities for social comparison and role modeling and the encouraging atmosphere. The trainers were appreciated for their competencies and personal feedback. Conclusions. Our adapted rolling group intervention for lower SES smokers was potentially effective as well as feasible, suitable, and acceptable for the target group. Further research should determine the intervention's effectiveness. Our detailed report about the adaptation process and resulting intervention may help reveal the mechanisms through which such interventions might operate effectively

Does collaborative research enhance the integration of research, policy and practice? The case of the Dutch Health Broker Partnership

Objectives: A gap between health services research and practice has been identified: research findings often do not find their way into practice. Our objective was to explore the potential of collaborative research to bridge this gap in one specific area, health promotion, and to determine factors that influence the development of theory-based practice and practice-based theory. Methods: This was investigated in an exploratory single-case study. First, we designed an analytical framework for collaborative research. Next, we used this framework to analyse developments in the Dutch Health Broker Partnership, which involved researchers, policymakers and practitioners. Data consisted of transcripts of the meetings of the Partnership over an 18-month period, as well as interviews with its 13 members. Results: The development of theory-based practice and practice-based theory failed to progress beyond the initial stages, although practitioners' actions did become more comprehensive and researchers' thinking became more influenced by practical limitations and local contexts. The heterogeneity of the Partnership facilitated as well as impeded the progress of these developments. Conclusions: Although collaborative research may serve as a tool to narrow the gap between research and practice, discussing the collaborative process and partner heterogeneity among the partners at the outset may be a necessary prerequisite to achieving the full potential of any partnership, which is limited by the ambivalent influence of partner heterogeneity. Collaborative research may, therefore, additionally benefit from continuous cross-domain orchestration and boundary work. Journal of Health Services Research & Policy Vol 17 No 4, 2012: 219-226 (C) The Royal Society of Medicine Press Ltd 201

Eating together as a social network intervention for people with mild intellectual disabilities: a theory-based evaluation

Purpose: People with mild intellectual disabilities (MID) generally live independently among the wider community. This can result in social exclusion and feelings of loneliness. Therefore, social work organizations aim to socially include people with MID through organizing activities in neighbourhoods that should lead to enlarged networks and increased societal participation. The “Communal Table” is such a, group-orientated, intervention that organizes monthly dinners in Amsterdam, the Netherlands. Because little is known about the effectiveness of interventions aiming to bring about social inclusion for people with MID we explored which types of participants were reached and whether and how the intervention brought about the intended outcomes. Methods: We performed a theory-based evaluation, using participatory observations and qualitative interviews (n = 19). The Communal Table attracted a diverse and loyal group of participants. Results: We distinguished four types of participants—lonely participants, activist participants, satisfied participants and calculating participants—whose pre-existing networks played a significant role in their individual needs for support and the outcomes of the intervention. Outcomes reported included experiences of conviviality and warmth, temporary relief of underlying problems and an overall positive opinion about the intervention, but network enlargement or increased societal participation were not reported. Conclusions: Our findings suggest that social network interventions for people with MID should be tailored to participants’ pre-existing networks and related individual needs to be successful

Individualisation in public health: reflections from life narratives in a disadvantaged neighbourhood

There is a dualism in current policy discourses on public health between neoliberal conceptions of health, and health as a product of social conditions. These conceptions also co-exist in the narratives of citizens. In this qualitative study carried out in the Netherlands, we analysed how people living in structural vulnerability perceive the potential tension of this dualism. Whereas the respondents’ narratives undoubtedly reflect the neoliberal view on health responsibility, their life stories revealed how health was a product of intergenerational transmission of poverty, violence and ill health. Neoliberal policies that expect citizens to minimise health risks were seen as unrealistic and raised feelings of apathy and fatalism. Behavioural messages were considered to oppose personal autonomy. Instead, the respondents appeared to envision health as a joint, balanced effort by themselves, their social network and public services. The tension between their own view on responsibility and the neoliberal view negatively affected their sense of self. These feelings were strengthened by the fact that the respondents felt abandoned by a government that calls upon self-sufficiency to deal with problems outside their control. On the other hand, they also stressed the importance of agency, particularly in breaking vicious transgenerational cycles. These findings indicate that the views of people living in disadvantaged neighbourhoods require further elucidation to develop a more nuanced and balanced view on responsibilities for health in public policies, and thus to prevent ignoring the problems faced by people who do not meet the expectations of current neoliberal policies