title: Translating policy into practice: a case study in the secondary prevention of coronary heart disease.
abstract: BACKGROUND
  This paper focuses on the relationships between health 'policy' as it is embodied in official documentation, and health 'practice' as reported and reflected on in the talk of policy-makers, health professionals and patients. The specific context for the study involves a comparison of policies relating to the secondary prevention of coronary heart disease (CHD) in the two jurisdictions of Ireland - involving as they do a predominantly state funded (National Health Service) system in the north and a mixed health-care economy in the south. The key question is to determine how the detail of health policy as contained in policy documents connects to and gets translated into practice and action.
  
  
  METHODS
  The data sources for the study include relevant health-care policy documents (N=5) and progress reports (N=6) in the two Irish jurisdictions, and semi-structured interviews with a range of policy-makers (N=28), practice nurses (14), general practitioners (12) and patients (13) to explore their awareness of the documents' contents and how they saw the impact of 'policy' on primary care practice.
  
  
  RESULTS
  The findings suggest that although strategic policy documents can be useful for highlighting and channelling attention to health issues that require concerted action, they have little impact on what either professionals or lay people do.
  
  
  CONCLUSIONS
  To influence the latter and to encourage a systematic approach to the delivery of health care it seems likely that contractual arrangements - specifying tasks to be undertaken and methods for monitoring and reporting on activity - are required.
authors.affiliation: School of Sociology, Social Policy & Social Work, Queen's University, BelfastCentre of Excellence for Public Health Medicine (NI), Queen's University, BelfastDiscipline of General Practice, NUI, GalwayDepartment of Public Health and Primary Care, Trinity College, DublinSchool of Psychology, NUI, GalwayDepartment of General Practice and Primary Care, Centre of Excellence for Public Health Medicine (NI), Queen's University, Belfast, UK.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Prior
authors.forename: Joanne
authors.initials: J
authors.lastname: Wilson
authors.forename: Michael
authors.initials: M
authors.lastname: Donnelly
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Murphy
authors.forename: Susan M
authors.initials: SM
authors.lastname: Smith
authors.forename: Mary
authors.initials: M
authors.lastname: Byrne
authors.forename: Molly
authors.initials: M
authors.lastname: Byrne
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Cupples
mesh_terms: D003327:Coronary Disease / Q000517:prevention & control*; D058006:General Practice / Q000379:methods*; D006291:Health Policy; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D007494:Ireland; D009660:Northern Ireland; D055502:Secondary Prevention / Q000379:methods*; D013222:State Medicine