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

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  • Wehrens, Rik
  • Bal, Roland

Abstract

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.

Suggested Citation

  • Wehrens, Rik & Bal, Roland, 2012. "Health programs struggling with complexity: A case study of the Dutch ‘PreCare’ project," Social Science & Medicine, Elsevier, vol. 75(2), pages 274-282.
    • Handle: RePEc:eee:socmed:v:75:y:2012:i:2:p:274-282
    DOI: 10.1016/j.socscimed.2012.02.052
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    References listed on IDEAS

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    1. Glasgow, R.E. & Lichtenstein, E. & Marcus, A.C., 2003. "Why Don't We See More Translation of Health Promotion Research to Practice? Rethinking the Efficacy-to-Effectiveness Transition," American Journal of Public Health, American Public Health Association, vol. 93(8), pages 1261-1267.
    2. Timmermans, Stefan & Almeling, Rene, 2009. "Objectification, standardization, and commodification in health care: A conceptual readjustment," Social Science & Medicine, Elsevier, vol. 69(1), pages 21-27, July.
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    3. Essén, Anna & Oborn, Eivor, 2017. "The performativity of numbers in illness management: The case of Swedish Rheumatology," Social Science & Medicine, Elsevier, vol. 184(C), pages 134-143.

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