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Towards guideline implementation for integrated local health policies: evaluation of an experimental implementation strategy in regional health services.

Theo JM Kuunders*, Mariëlle JCM Cloin, Marja JH van Bon-Martens, Theo GWM Paulussen, Hans AM van Oers, Ien AM van de Goor

Background: To enhance implementation of a Guideline for integrated local health policy, a draft implementation strategy (DIS) was developed. It was hypothesized that the DIS would be feasible and effective to enhance the use of a Guideline for integrated local health policy. To examine its feasibility and effectiveness, the DIS was pilot tested simultaneously in two Regional Health Services (RHSs) and compared with the 'care as usual' in two other RHSs that did not receive a predefined strategy for Guideline implementation. Material and methods: The DIS was evaluated in a qualitative way by means of semi-structured individual-and group interviews. We applied the Nutbeam framework for evaluation on: i) program integrity, ii) program reach, iii) program acceptability, and iv) observed change. Comparison of pilot results with the two other RHSs included semi-structured group interviews. Main findings: Both RHSs conducted implementation largely as planned. The purpose of the Guideline for RHS policy objectives was not discussed at all desired levels. Increased Guideline use was mainly found among health promoters. Comparison with Guideline implementation in the other RHSs revealed information for further evaluation of the DIS. Conclusion: The feasibility and effectiveness of the DIS applied to building blocks which aimed at alignment of goals and ambitions between RHS management and executive disciplines. Possible implications for future application of the DIS are dealt with in the discussion section of this paper.