Beyond Two Communities. The co-production of research, policy and practice in collaborative public health settings

This thesis empirically focuses on the phenomenon of the ACCs. It does so in several ways: by investigating the general development of the ACCs over the last five years, but also by an in-depth analysis of four collaborative research projects that have been conducted in the context of these ACCs. However, this thesis does not take the notion of ‘two communities’ for granted, but rather seeks to take into account other conceptualizations of the relation between scientific knowledge production, policy development and professional practice. One of the most promising conceptualizations, which may provide analysts with more ‘analytical rigor’ than the ‘two communities’ framework is able to provide, is the notion of ‘co-production’ (Jasanoff, 2004). This radically different view on science/ policy relations focuses on how natural and social orders, or science and policy, are being produced simultaneously and interactively. Such a perspective sheds a radically different light on the interactions between researchers and policy makers. The aim of this thesis is to investigate whether a conceptualization of research/policy/practice relations in terms of this co-production framework serves as a better tool to understand these relations and interactions than the two communities perspective is able to provide

Who is ‘in’ and who is ‘out’? Participation of older persons in health research and the interplay between capital, habitus and field

Inclusion and exclusion processes in community engagement do not take place in a vacuum, but are embedded in social, political and institutional contexts. T

Understanding Each Other In The Medical Encounter: Exploring therapists' and patients' understanding of each other's experiential knowledge through the Imitation Game

The ability of healthcare professionals to understand the lived experiences of their patients has become increasingly important, but has been a difficult topic to investigate empirically because it involves two distinctive research strands: interpretive phenomenological analysis (IPA) and patient-provider communication (PPC). While IPA focuses on experiences and illness narratives of patients, but not on therapist’s understanding of those, PPC surveys focus primarily on effective forms of communication without addressing the actual illness experiences of patients. There is a need for empirical research that combines both strands to investigate not only the experiences of patients, but also whether professionals are able to understand these. This study combined both strands by means of a novel research method called the Imitation Game (combined with other qualitative methods). This sociological method was developed to investigate what different social groups know of each other’s lifeworld. This article focused on the important domain of eating disorder treatment to investigate whether therapists were able to understand the experiences of their patients and vice versa. The study provide insights into the domains in which therapists and patients were able to develop insights into each other’s experiential knowledge (and where they had difficulties in doing so). The findings also implicate the high potential of the Imitation Game as an interdisciplinary research method. We propose that the Imitation Game may be particularly valuable as a ‘can opener’ that enables the development of in-depth, qualitative insights into the substantive themes that matter in the lifeworlds of patients and therapists

Understanding each other in the medical encounter: Exploring therapists’ and patients’ understanding of each other’s experiential knowledge through the Imitation Game

The ability of health-care professionals to understand the lived experiences of their patients has become increasingly important but has been a difficult topic to investigate empirically because it involves two distinctive research strands: interpretative phenomenological analysis and patient–provider communication. While interpretative phenomenological analysis focuses on experiences and illness narratives of patients, but not on therapist’s understanding of those, patient–provider communication surveys focus primarily on effective forms of communication without addressing the actual illness experiences of patients. There is a need for empirical research that combines both strands to investigate not only the experiences of patients but also whether professionals are able to understand these. This study combined both strands by means of a novel research method called the Imitation Game (combined with other qualitative methods). This sociological method was developed to investigate what different social groups know of each other’s lifeworld. It focused on the important domain of eating disorder treatment to investigate whether therapists were able to understand the experiences of their patients and vice versa. This study provides insights into the domains in which therapists and patients were able to develop insights into each other’s experiential knowledge (and where they had difficulties in doing so). The findings also implicate the high potential of the Imitation Game as an interdisciplinary research method. We propose that the Imitation Game may be particularly valuable as a ‘can opener’ that enables the development of in-depth, qualitative insights into the substantive themes that matter in the lifeworlds of patients and therapists

Epistemic virtues and data-driven dreams: on sameness and difference in the epistemic cultures of data science and psychiatry

Data science and psychiatry have diverse epistemic cultures that come together in data-driven initiatives (e.g., big data, machine learning). The literature on these initiatives seems to either downplay or overemphasize epistemic differences between the fields. In this paper, we study the convergence and divergence of the epistemic cultures of data science and psychiatry. This approach is more likely to capture where and how the cultures differ and gives insights into how practitioners from both fields find ways to work together despite their differences. We introduce the notions of “epistemic virtues” to focus on epistemic differences ethnographically, and “trading zones” to concentrate on how differences are negotiated. This leads us to the following research question: how are epistemic differences negotiated by data science and psychiatry practitioners in a hospital-based data-driven initiative? Our results are based on an ethnographic study in which we observed a Dutch psychiatric hospital department developing prediction models of patient outcomes based on machine learning techniques (September 2017 – February 2018). Many epistemic virtues needed to be negotiated, such as completeness or selectivity in data inclusion. These differences were traded locally and temporarily, stimulated by shared epistemic virtues (such as a systematic approach), boundary objects and soc

Perspectives of nursing professionals and older adults differ on aspects of care for older people after a nationwide improvement program

Background: The perspectives of nursing professionals might differ from those of older adults when it comes to care for older people. This cross-sectional study compares the views of older adults with the views of nursing professionals on the quality of care after a nationwide improvement program for care for older people was implemented (2008-2016) in the Netherlands. Methods: Questionnaire data were used from 385 nursing professionals (response rate 51%) that were part of the Nursing Staff Panel, a nationwide representative group of nursing staff, and working in home care, hospitals or general practices. Additionally, questionnaire data were used from 73 older adults (response rate 81%) who were involved in regional networks to discuss project proposals and to represent the voice of older adults in the nationwide improvement program. Partic

Health programs struggling with complexity: A case study of the Dutch 'PreCare' project

This article aims to understand the effects of rationalized health programs (the basic components of which are efficiency, calculability, predictability and control) on local practices. We discuss how a successful U.S. intervention in preventive youth health care (the Nurse Family Partnership) has been translated and adapted within a Dutch setting. The Dutch version of the program is called 'PreCare'. The empirical analysis highlights the effects of rationalized health programs on local practices, in terms of the amount of work required, how local practices are disciplined, how these programs (re)draw boundaries, the 'travel expenditures' involved (and developed 'coping strategies'), and how local practices (try to) reshape the program. Our empirical analysis builds on a combination of qualitative methods. We conducted 16 semi-structured interviews with 19 people involved in the PreCare program. The majority of the interviews were conducted between July and November 2008. We also conducted an analysis of relevant documents related to the PreCare intervention and protocol. Furthermore, we observed at several meetings, including case conferences and management intervision meetings.The article makes a theoretical and practical contribution to the field. Theoretically, we show how the rationalization process is linked to a broader development of quantification and how both developments are based on a particularly modern ontology and epistemology in which what is considered 'real' and 'knowledgeable' becomes closely tied to what is measurable. The article offers a different conceptualization of rationalized health programs, one that acknowledges the need to standardize some elements, but also recognizes the need to be open and flexible toward local practices. We specifically focus on the tools that are able to deal with both the need to standardize . and the need to be open toward local practices. We suggest that '(re)writing devices' are a fruitful category of tools for this purpose

Coordination of research, policy and practice: A case study of collaboration in the field of public health

Public health policies and services are increasingly scrutinized for their quality and accountability and 'evidence-based' ways of working are becoming more important in most public sector activities. In the Netherlands this led to the development of academic collaborative centers (ACCs) for public health: formal, long-term collaborations between municipal health services, university departments and other stakeholders. In this paper we argue that discussing issues of research uptake or research utilization in terms of 'gaps' that need to be 'bridged' is unproductive when analyzing structural collaborations or partnerships between researchers, policy-makers and practitioners. Within collaborative settings such as the ACCs, the clear distinction between what counts as 'science' and what counts as 'policy' is only one side of the story. We use the notions of 'boundary organization' and 'front stage and back stage settings' to analyze a case study of a collaborative project conducted within one of the ACCs

Dutch Academic Collaborative Centres for Public Health: development through time – issues, dil

While much research utilisation literature shows an increasing emphasis on the added value of structural partnerships, which should facilitate prolonged interactions between researchers, policy makers and professionals, the question of how such collaborative structures develop over time and what consequences that has in terms of collaboration is usually neglected. This paper offers an empirical analysis of a Dutch partnership format developed over a period of four years, based on two interview rounds conducted between 2007 and 2010, supplemented with document analysis and a focus group. It focuses on changing challenges and dilemmas in different development stages and outlines which strategies are used

Hybrid Management Configurations in Joint Research

__Abstract__ Researchers are increasingly expected to deliver ‘‘socially robust knowledge’’ that is not only scientifically reliable but also takes into account demands from societal actors. This article focuses on an empirical example where these additional criteria are explicitly organized into research settings. We investigate how the multiple ‘‘accountabilities’’ are managed in such ‘‘responsive research settings.’’ This article provides an empirical account of such an organizational format: the Dutch Academic Collaborative Centres for Public Health. We present a cross-case analysis of four collaborative research projects conducted within this context. We build on (and extend) Miller’s notion of ‘‘hybrid management.’’ The article shows that the extended concept of hybrid management is useful to study the different accountabilities encountered in such settings. We analyze how the collaboration developed and which conflicts or dilemmas arose. We then focus on the different hybrid management strategies used in the collaboration. The empirical material shows how the different aspects of hybrid management feature in various configurations in the four projects. We highlight that hybrid management strategies may be used by different groups or at different moments, may reinforce or contradict each other, and may be more or less effective at different points in time