An application of Extended Normalisation Process Theory in a randomised controlled trial of a complex social intervention: Process evaluation of the Strengthening Families Programme (10–14) in Wales, UK

Abstract

PurposeProcess evaluations generate important data on the extent to which interventions are delivered as intended. However, the tendency to focus only on assessment of pre-specified structural aspects of fidelity has been criticised for paying insufficient attention to implementation processes and how intervention-context interactions influence programme delivery. This paper reports findings from a process evaluation nested within a randomised controlled trial of the Strengthening Families Programme 10–14 (SFP 10–14) in Wales, UK. It uses Extended Normalisation Process Theory to theorise how interaction between SFP 10–14 and local delivery systems - particularly practitioner commitment/capability and organisational capacity - influenced delivery of intended programme activities: fidelity (adherence to SFP 10–14 content and implementation requirements); dose delivered; dose received (participant engagement); participant recruitment and reach (intervention attendance).MethodsA mixed methods design was utilised. Fidelity assessment sheets (completed by practitioners), structured observation by researchers, and routine data were used to assess: adherence to programme content; staffing numbers and consistency; recruitment/retention; and group size and composition. Interviews with practitioners explored implementation processes and context.ResultsAdherence to programme content was high - with some variation, linked to practitioner commitment to, and understanding of, the intervention’s content and mechanisms. Variation in adherence rates was associated with the extent to which multi-agency delivery team planning meetings were held. Recruitment challenges meant that targets for group size/composition were not always met, but did not affect adherence levels or family engagement. Targets for staffing numbers and consistency were achieved, though capacity within multi-agency networks reduced over time.ConclusionsExtended Normalisation Process Theory provided a useful framework for assessing implementation and explaining variation by examining intervention-context interactions. Findings highlight the need for process evaluations to consider both the structural and process components of implementation to explain whether programme activities are delivered as intended and why.

Needs assessment for cultural adaptation of Strengthening Families Program (SFP 10-14-UK) in Brazil

“…The insertion of such families in the groups demands other strategies of intervention and affects the group process, possibly causing demotivation and hopelessness among the participants. These findings are in line with those of Segrott et al (2017), which also pointed out a challenge to recruit families for the SFP in Wales, UK. Therefore, investments in the recruitment, selection, and preparation of the families for inclusion in the program should be a priority.…”

Barriers and Facilitators in the Strengthening Families Program (SFP 10–14) Implementation Process in Northeast Brazil: A Retrospective Qualitative Study

“…As such, it should be noted that the majority of incentives considered helpful for the implementation involved better communication between the intersectoral networks, greater involvement of implementation agents in prevention policy and the program, and better understanding of the primary prevention objective and the intervention itself. These last aspects are consistent with findings of an evaluation of the SFP 10–14 implementation process in Wales, United Kingdom, which also identified greater commitment to the intervention by professionals who understood its mechanisms and content as facilitating the implementation [ 33 ]. Additionally, positive strategies were developed from earlier experience implementing SFP 10–14 or from prior knowledge of prevention.…”

Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review

“…Scantlebury [ 125 ] UK NPT Maternity unit electronic health record Systematic review [ 192 ] Yes Process evaluation Qualitative Prospective Yes Yes N/A 90. Segrott et al [ 126 ] UK ENPT Adolescent substance misuse programmes Systematic review [ 193 ] Yes Process evaluation Mixed Prospective Yes Yes Yes 91. Shemeili [ 127 ] Abu Dhabi NPT Medicines management in hospital care of older people Yes Process evaluation Qualitative Prospective Yes No N/A 92.…”