Bridging the gap between doctors and policymakers.

Background: The decentralization of school health care policy in The Netherlands was followed by an increase in diversity, which was most often not evidence-based. This study aims to clarify the use of scientific knowledge in school health care policy-making processes: multi-actor processes in networks, trying to solve certain problems. Methods: Case-study design in four Municipal Health Service regions, using documents and half-structured interviews as data sources. Results: Scientific knowledge is used by only 42% of the actors in 58% of decision-making rounds in policy-making processes. 'Recent' regional data on health indicators are used more often than 'established' (inter)national knowledge of theoretical models. Mainly school health professionals use knowledge as a resource to influence the policy process. Other actors (e.g. managers and municipalities) use formal power, money or 'initiative' as their main resources. Powerful actors put forward less scientific knowledge than actors in dependent positions. Individual actors with a combined scientific and political frame of reference put forward knowledge most frequently, especially in complex networks with many actors, more than one powerful actor, more than one arena, more than one dominant resource and more than one dominant frame of reference. Conclusion: The use of scientific knowledge in school health care policymaking processes can and must be improved. Liaison officers can bridge the gap between doctors and policymakers, especially in complex policy networks. They combine a scientific and a political frame of reference and act upon scientific knowledge as a resource in their efforts to influence the policymaking process. [ABSTRACT FROM AUTHOR]