Background
Discussion
The value of theory for implementation science
Rationale for using normalisation process theory
NPT Constructs | |||
Coherence | Cognitive Participation | Collective Action | Reflexive Monitoring |
Can stakeholders make sense of the intervention? | Can stakeholders get others involved in implementing the intervention? | What needs to be done to make the intervention work in practice? | Can the intervention be monitored and evaluated? |
Sub-constructs | |||
Differentiation | Enrolment | Interactional workability | Systematisation |
Do stakeholders see this as a new way working? | Do the stakeholders believe they are the correct people to drive forward the implementation? | Does the intervention make it easier or harder to complete tasks? | Will stakeholders be able to judge the effectiveness of the intervention? |
Individual specification | Initiation | Skill set workability | Individual appraisal |
Do individuals understand what tasks the intervention requires of them? | Are they willing and able to engage others in the implementation? | Do those implementing the intervention have the correct skills and training for the job? | How will individuals judge the effectiveness of the intervention? |
Communal specification | Activation | Relational integration | Communal appraisal |
Do all those involved agree about the purpose of the intervention? | Can stakeholders identify what tasks and activities are required to sustain the intervention? | Do those involved in the implementation have confidence in the new way of working? | How will stakeholders collectively judge the effectiveness of the intervention? |
Internalisation | Legitimation | Contextual integration | Reconfiguration |
Do all the stakeholders grasp the potential benefits and value of the intervention? | Do they believe it is appropriate for them to be involved in the intervention? | Do local and national resources and policies support the implementation? | Will stakeholders be able to modify the intervention based on evaluation and experience? |
Operationalising NPT in implementation research: the need for an effective methodology to explore and support implementation science
‘Because of the reciprocal interactions between context and program success, researchers should engage ‘on-the-ground’ service practitioners as partners in the research process. Locally owned and driven programs produce more useful research questions and data that are more valid for practitioners and policymakers’. ([15], pp 581-562)
Participatory Learning and Action (PLA) research
Reversal from… | to |
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Assuming knowledge… | exploring and exchanging complex ‘knowledges’ |
Hierarchical relationships among stakeholders… | reciprocal and mutually empowering relationships |
Viewing stakeholders as passive beneficiaries… | viewing stakeholders as active partners and collaborators who benefit differentially from research outcomes |
Viewing stakeholders as problem makers… | to engaging with them as problem-solvers |
NPT and PLA: working together to incrementally increase knowledge in implementation contexts
NPT Construct | NPT informed questions re community participation in primary healthcare explored in PLA fieldwork | Problems in the practice of community participation in primary healthcare identified with stakeholders during PLA fieldwork that impact on implementation | Recommended actions |
---|---|---|---|
Coherence | How is service user involvement defined? | Multiple terms are in use. People use the same terms to mean different things. There is lack of shared understanding about the work involved across stakeholders. | All stakeholders clarify their own understanding of community participation in primary healthcare and, through dialogue with each other, arrive at a shared understanding of community participation in primary healthcare with other stakeholders at the start of a community participation project. |
Cognitive Participation | Why do stakeholders get involved? | There is a lack of clarity about why different stakeholders get involved. People get involved for different reasons and there is a lack of understanding about the roles that people play. | Stakeholders work together to clarify who needs to be involved and agree to work together to drive the implementation of a community participation in primary care project forward. |
Collective Action | What methods are used? | Involvement can be tokenistic. There is often a lack of adequate resources and skills to do the work meaningfully. Stakeholders are not clear about their individual roles. | All stakeholders should have appropriate organisational support, skills and training, trust in the work and the ability to perform all tasks involved in order to make an activity or process take place. |
Reflexive Monitoring | What are the outcomes? | It is difficult to evaluate the impact of community participation in primary healthcare. Evaluation is often ad hoc and/or anecdotal. | Stakeholders will appraise their work, using formal and informal systems, so that they can learn about what is working well and can modify work practices to maximize community participation in primary healthcare. |