The authors declare that they have no competing interests.
IS and AvG conceived and coordinated the multiple case study, participated as case study researchers, carried out the qualitative interviews, questionnaires and observations, developed the stepwise approach, conducted data analyses and prepared the first draft of the manuscript. HvO and IvdG provided advice during the multiple case study and comment the manuscript critically. All authors contributed to and approved of the final version of the manuscript.
IS is a senior researcher in the field of Health in all policies/Integral health policy. She works at the Centre for Health and Society at National Institute of Public Health and Environment (RIVM) and was part-time seconded at Tilburg University/Tranzo Scientific Center for Care and Welfare. AvG is an epidemiologist at the Regional Public Health Services Brabant-Zuidoost (GGD BZO) and was part-time seconded at Tilburg University/Tranzo Scientific Center for Care and Welfare. HvO is Chief Science Officer Health System Assessment and Policy Support at RIVM and a professor in Public Health at Tilburg University/Tranzo Scientific Center for Care and Welfare. IvdG is a professor in Effectiveness Individual Prevention at Tilburg University/Tranzo Scientific Center for Care and Welfare.
Although public health and primary care share the goal of promoting the health and wellbeing of the public, the two health sectors find it difficult to develop mutually integrated plans and to collaborate with each other. The aim of this multiple case study was to compare seven neighbourhoods in which a stepwise approach based on two central tools (district health profile and policy dialogue) was used to develop integrated district plans and promote collaboration.
The stepwise approach involved the following steps: 1 Getting to know the neighbourhood, 2 Assembling the workgroup, 3 Analysing the neighbourhood, 4 Developing a district health profile, 5 Preparing policy dialogue, 6 Holding local dialogues, 7 Embedding integrated district plans and collaboration. To supervise this process, a core team was assembled for each neighbourhood, consisting of people drawn from both public health and primary care. Both the use of the two tools and the collaboration were studied by means of documentary analysis, interviews, questionnaires and observations.
The seven neighbourhoods differed in the way the two tools of the stepwise approach were used: general versus focused profiles, the actors involved, the aims of the dialogue or the intensity of the steps. There were also similarities: profile indicators (e.g., population prognosis, vulnerability) and dialogue themes (e.g., obesity, social cohesion). The local actors experienced that the combination of both tools facilitates the process of bringing public health and primary care closer together, and that it is essential to invest sufficiently in the integration of profile data and in involving appropriate actors in the dialogue (e.g., GPs, residents). Collaboration was perceived as positive (e.g., feels involved, focus on consensus), but a starting process. Local actors also believe that the stepwise approach supported the process.
A stepwise approach involving the combined use of district health profiles and policy dialogues promotes the integrated planning of health activities and facilitates collaboration between public health and primary care at the local level. Local differences may arise in the intensity and form of the various steps, but because they are practical and clearly defined, they remain transferrable to other neighbourhoods.