Realist Approach to Social Policies (RASP) study to reduce socioeconomic health inequalities through systems change: protocol for a research project combining mixed-methods realist research with institutional action research.

INTRODUCTION: Health inequalities are rooted in inequality in vital resources for health, including financial resources, a supportive informal network, a stable living situation, work or daytime activities or education and literacy. About 25% of Dutch citizens experience deprivation of such resources. Social policy consists of crucial instruments for improving resources in those groups but can also have adverse effects and lead to additional burdens. This project aims to contribute to the reduction of health inequalities through (1) a better understanding of how social policy interventions can contribute to reducing health inequality through the redistribution of burdens and resources and (2) developing anticipatory governance strategies to implement those insights, contributing to a change in social policy systems. METHODS AND ANALYSIS: Two systems approaches are combined for establishing a systems change in the Netherlands. First, a realist approach enables insights into what in social policy interventions may impact health outcomes, for whom and under what circumstances. Second, an institutional approach enables scaling up these insights, by acknowledging the crucial role of institutional actors for accomplishing a systems change. Together with stakeholders, we perform a realist review of the literature and identify existing promising social policy interventions. Next, we execute mixed-methods realist evaluations of selected social policy interventions in seven municipalities, ranging from small, mid-size to large, and in both urban and rural settings. Simultaneously, through action research with (national) institutional actors, we facilitate development of anticipatory governance strategies. ETHICS AND DISSEMINATION: This study is not liable to the Medical Research Involving Subjects Act (WMO). Informed consent to participate in the study is obtained from participants for the use of all forms of personally identifiable data. Dissemination will be codeveloped with target populations and includes communication materials for citizens, education materials for students, workshops, infographics and decision tools for policy-makers and publications for professionals.

Understanding the Microfoundations of Government-Civil Society Relations.

This article adds a much needed microlevel perspective to the literature on interactions between civil society organizations and governments. I argue that a microlevel perspective assists in making connections between two dominant streams in the literature on government-CSO relations: an empirical-analytical stream and a critical stream. It aims to better understand the interactions and relations, by analysing the institutional work done by CSOs' members. Adopting this approach puts CSO members in a more agentic position. Interactional processes are brought to the centre of analysis. The Dutch Community Sport Coach programme was used as a case to illustrate the usefulness of the approach. Through a one-year organizational ethnography, the article scrutinizes the way in which members of one CSO enact the organization's service delivery relationship with a municipality. Through a multidimensional perspective on agency, the analysis shows how individual CSO members act as embedded agents that assimilate a public logic into the dominant community logic. It further shows the CSO's members efforts and struggle to maintain their community logic. The article argues that an analysis of the microfoundations of government-civil society organization relations foregrounds the multivocality of the relationship as foundational.