Meet the local policy workers: Implementation of health promotion guidelines in Denmark

Abstract

Reporting on an interview and observation-based study in Danish municipalities, this article deals with local policy workers and takes it's departure in the great variation we observed in implementation of centrally issued health promotion guidelines. We present five types of local policy workers, each of whom we found typified a specific way of reasoning and implementing the guidelines. This typology illustrates the diversity found within a group of local policy workers and helps explain the variability reported in most studies on policy/guideline implementation. On the level of individuals, variation in implementation is often explained by the implementers’ perceptions of need for, and potential benefits of the policy, self-efficacy and skill proficiency. We add ‘professionally related experiences’ as another explanation. We introduce the concepts of translation and hinterland to understand how and why people in the same positions receiving the same set of guidelines implement them differently and suggest that local policy workers’ professionally related experiences affect the frames in which they translate the guidelines and decide upon the strategies of implementation. As such, this article illustrates a residual order of implementation practice: the unruly and elusive part of public policy implementation, ordered only partly by the centrally issued policies.