Public health measures during the COVID-19 pandemic through the lens of community organisations and networks in the Netherlands (2020-2021): five lessons for pandemic decision-making.

BackgroundDuring the coronavirus disease (COVID-19) pandemic, key persons who were formally or informally active in community organisations and networks, such as sports clubs or cultural, educational, day care and healthcare facilities, occupied a key position between governments and citizens. However, their experiences, the dilemmas they faced and the solutions they generated when implementing COVID-19 measures in their respective settings are understudied.AimWe aimed to understand how key persons in different community organisations and networks experienced and responded to the COVID-19 measures in the Netherlands.MethodsBetween October 2020 and December 2021, the Corona Behavioural Unit at the Dutch national public health institute, conducted qualitative research based on narratives derived from 65 in-depth interviews with 95 key persons from 32 organisations and networks in eight different sectors.ResultsFirstly, key persons enhanced adherence and supported the resilience and well-being of people involved in their settings. Secondly, adherence was negatively affected where COVID-19 measures conflicted with important organisational goals and values. Thirdly, small changes and ambiguities in COVID-19 policy had substantial consequences, depending on the context. Fourthly, problem-solving was achieved through trial-and-error, peer support, co-creation and transparent communication. Lastly, the COVID-19 pandemic and measures highlighted inequalities in access to resources.ConclusionPandemic preparedness requires organisational and community preparedness and a multidisciplinary public health approach. Structural engagement of governments with key persons in community organisations and networks is key to enhance public trust and adherence to pandemic measures and contributes to health equity and the well-being of the people involved.

Analyzing the contributions of a government-commissioned research project: a case study.

BACKGROUND: It often remains unclear to investigators how their research contributes to the work of the commissioner. We initiated the 'Risk Model' case study to gain insight into how a Dutch National Institute for Public Health and the Environment (RIVM) project and its knowledge products contribute to the commissioner's work, the commissioner being the Health Care Inspectorate. We aimed to identify the alignment efforts that influenced the research project contributions. Based on the literature, we expected interaction between investigators and key users to be the most determining factor for the contributions of a research project. METHODS: In this qualitative case study, we analyzed the alignment efforts and contributions in the Risk Model project by means of document analysis and interviews according to the evaluation method Contribution Mapping. Furthermore, a map of the research process was drafted and a feedback session was organized. After the feedback session with stakeholders discussing the findings, we completed the case study report. RESULTS: Both organizations had divergent views on the ownership of the research product and the relationship between RIVM and the Inspectorate, which resulted in different expectations. The RIVM considered the use of the risk models to be problematic, but the inspectors had a positive opinion about its contributions. Investigators, inspectors, and managers were not aware of these remarkably different perceptions. In this research project, we identified six relevant categories of both horizontal alignment efforts (between investigators and key users) as well as vertical alignment efforts (within own organization) that influenced the contributions to the Inspectorate's work. CONCLUSIONS: Relevant alignment efforts influencing the contributions of the project became manifest at three levels: the first level directly relates to the project, the second to the organizational environment, and the third to the formal and historical relationship between the organizations. Both external and internal alignments influence the contributions of a research project. Based on the findings, we recommend that research institutes invest in a reflective attitude towards the social aspects of research projects at all levels of the organization and develop alignment strategies to enhance the contributions of research.

Research for Policy (R4P): development of a reflection tool for researchers to improve knowledge utilization.

BACKGROUND: To improve knowledge utilization in policymaking, alignment between researchers and policymakers during knowledge production is essential, but difficult to maintain. In three previously reported case studies, we extensively evaluated complex research projects commissioned by policymakers to investigate how alignment is achieved in a research process and to discover ways to enhance knowledge contributions to health policy. In the present study, we investigated how the findings of these three research projects could be integrated into a practical tool for researchers to enhance their contribution to evidence-based policy. METHODS: A cross-case analysis was conducted to integrate the findings of the evaluation of the three research projects and to identify important alignment areas in these projects. By means of an iterative process, we prepared a tool that includes reflection questions for researchers. The "Research for Policy" tool was tested with input from the project managers of three new research projects. Based on the findings, the final version of the Research for Policy tool was prepared. RESULTS: By cross-case analysis of the three case studies, the following important alignment areas were identified: the goal, quality, relevance, timing, and presentation of research, the tasks and authorities of actors, the consultative structure and vertical alignment within organizations, and the organizational environment. The project managers regarded the Research for Policy tool as a useful checklist for addressing the important alignment areas in a research project. Based on their feedback, the illustrative examples from the case studies were added to the reflection questions. The project managers suggested making the tool accessible not only to researchers but also to policymakers. The format of the Research for Policy tool was further adjusted to users' needs by adding clickable links. CONCLUSIONS: Alignment between research and policymaking requires continuous efforts and a clear understanding of process issues in the research project. The Research for Policy tool offers practical alignment guidance and facilitates reflection on process issues, which supports researchers in aligning with policymakers and in acting in a context-sensitive way.

Validity and Reliability of the eHealth Analysis and Steering Instrument.

BACKGROUND: eHealth services can contribute to individuals' self-management, that is, performing lifestyle-related activities and decision making, to maintain a good health, or to mitigate the effect of an (chronic) illness on their health. But how effective are these services? Conducting a randomized controlled trial (RCT) is the golden standard to answer such a question, but takes extensive time and effort. The eHealth Analysis and Steering Instrument (eASI) offers a quick, but not dirty alternative. The eASI surveys how eHealth services score on 3 dimensions (ie, utility, usability, and content) and 12 underlying categories (ie, insight in health condition, self-management decision making, performance of self-management, involving the social environment, interaction, personalization, persuasion, description of health issue, factors of influence, goal of eHealth service, implementation, and evidence). However, there are no data on its validity and reliability. OBJECTIVE: The objective of our study was to assess the construct and predictive validity and interrater reliability of the eASI. METHODS: We found 16 eHealth services supporting self-management published in the literature, whose effectiveness was evaluated in an RCT and the service itself was available for rating. Participants (N=16) rated these services with the eASI. We analyzed the correlation of eASI items with the underlying three dimensions (construct validity), the correlation between the eASI score and the eHealth services' effect size observed in the RCT (predictive validity), and the interrater agreement. RESULTS: Three items did not fit with the other items and dimensions and were removed from the eASI; 4 items were replaced from the utility to the content dimension. The interrater reliabilities of the dimensions and the total score were moderate (total, κ=.53, and content, κ=.55) and substantial (utility, κ=.69, and usability, κ=.63). The adjusted eASI explained variance in the eHealth services' effect sizes (R(2) =.31, P<.001), as did the dimensions utility (R(2) =.49, P<.001) and usability (R(2) =.18, P=.021). Usability explained variance in the effect size on health outcomes (R(2) =.13, P=.028). CONCLUSIONS: After removing 3 items and replacing 4 items to another dimension, the eASI (3 dimensions, 11 categories, and 32 items) has a good construct validity and predictive validity. The eASI scales are moderately to highly reliable. Accordingly, the eASI can predict how effective an eHealth service is in regard to supporting self-management. Due to a small pool of available eHealth services, it is advised to reevaluate the eASI in the future with more services.

[The 'multimorbidity generalist' is the future]. / De 'multimorbiditeitsdokter' heeft de toekomst.

The 'multimorbidity generalist' is the future. Such doctors will prove to be key to sustainable healthcare systems in the 21st century. The multimorbidity generalist combines preventive, generalist (i.e. system-based), and coaching competencies to treat the increasingly multimorbid patient populations in a patient-centred, effective and efficient way. The medical profession must now dare to take the lead and employ self-regulating policies that will legitimise and strengthen the role of the multimorbidity generalist within in the Dutch healthcare system.