Figure 4.

True integration of pharmacogenomics in primary health care requires different transitions [adapted from (Rotmans et al., 2001; Geels and Schot, 2002; Geels, 2007)]. Local or stakeholder-specific initiatives will need to transform to a patchwork of multi-stakeholder collaborations which could create pressure to sustainably change the existing health care culture, structure, and practice. This could be achieved by joint efforts to 1) broaden implementation: transitioning from the pre-development to take-off phase of transitions requires effective learning processes on multiple dimensions; 2) deepening implementation: transitioning from the take-off phase to acceleration of transitions requires attunement and collaboration between stakeholders to align (lessons) from earlier niche applications; and 3) scaling-up implementation: transitioning from the acceleration to stabilization phase of transitions requires true changes in thinking, organizing, and doing of stakeholders. Furthermore, taking advantage of windows of opportunities (*) to next phases in transition (often achieved by alignment of different initiatives and/or stakeholders) could facilitate structuration and thereby integration of new ways of thinking, doing, and organizing.