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  • 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

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Protocol
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
  1. Jantien Van Berkel1,2,
  2. Ernst-Jan de Bruijn3,
  3. Maikel Waardenburg4,
  4. Yvonne la Grouw4,
  5. Eline van Bennekom1,2,
  6. Hilje van der Horst2,
  7. Susanne Tonnon5,
  8. Milou Haggenburg- Mohammed6,
  9. Annemien Haveman-Nies2,7,
  10. Tamara Madern5,
  11. Marike Knoef3,8,
  12. Emely de Vet2,9
  1. 1Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherlands
  2. 2Consumption and Healthy Lifestyles, Wageningen Universiteit en Research, Wageningen, The Netherlands
  3. 3Institute of Tax Law and Economics | Department of Economics, Leiden University, Leiden, The Netherlands
  4. 4Law, Economics and Governance, School of Governance, Utrecht University, Utrecht, The Netherlands
  5. 5Debt and Collection, Hogeschool Utrecht, Utrecht, The Netherlands
  6. 6Onderzoek en Statistiek, Gemeente Amsterdam, Amsterdam, The Netherlands
  7. 7AGORA Academische Werkplaats, GGD Noord en Oost Gelderland, Warnsveld, The Netherlands
  8. 8Tilburg School of Economics and Management, Tilburg University, Tilburg, The Netherlands
  9. 9Tilburg School of Humanities and Digital Sciences, Liberal Arts and Sciences, Tilburg University, Tilburg, The Netherlands
  1. Correspondence to Dr Jantien Van Berkel; j.vanberkel{at}uu.nl

Abstract

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.

  • Health Equity
  • Community-Based Participatory Research
  • MENTAL HEALTH
  • Overweight
  • Smoking Reduction
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2024-088571

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    Footnotes

    • Contributors JVB led the development of the study protocol and is the research guarantor. JVB, E-JdB, MW, YlG, EvB, HvdH, ST, MH-M, AH-N, TM, MK and EdV have provided intellectual input and critically reviewed the study protocol. All authors approved the final manuscript.

    • Funding This work is supported by the Dutch Research Agenda, executed by NWO and ZonMw, grant number NWA 1333.19.001. Independent peer reviews were part of the application process.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.