Developing, delivering and evaluating primary mental health care: the co-production of a new complex intervention

Abstract

BackgroundHealth services face the challenges created by complex problems, and so need complex intervention solutions. However they also experience ongoing difficulties in translating findings from research in this area in to quality improvement changes on the ground. BounceBack was a service development innovation project which sought to examine this issue through the implementation and evaluation in a primary care setting of a novel complex intervention.MethodsThe project was a collaboration between a local mental health charity, an academic unit, and GP practices. The aim was to translate the charity’s model of care into practice-based evidence describing delivery and impact. Normalisation Process Theory (NPT) was used to support the implementation of the new model of primary mental health care into six GP practices. An integrated process evaluation evaluated the process and impact of care.ResultsImplementation quickly stalled as we identified problems with the described model of care when applied in a changing and variable primary care context. The team therefore switched to using the NPT framework to support the systematic identification and modification of the components of the complex intervention: including the core components that made it distinct (the consultation approach) and the variable components (organisational issues) that made it work in practice. The extra work significantly reduced the time available for outcome evaluation. However findings demonstrated moderately successful implementation of the model and a suggestion of hypothesised changes in outcomes.ConclusionsThe BounceBack project demonstrates the development of a complex intervention from practice. It highlights the use of Normalisation Process Theory to support development, and not just implementation, of a complex intervention; and describes the use of the research process in the generation of practice-based evidence. Implications for future translational complex intervention research supporting practice change through scholarship are discussed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1726-6) contains supplementary material, which is available to authorized users.

Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review

“…Quantitative and document analysis designs were utilised once each. Among the 25 articles using qualitative methods only, ten used semi-structured interviews [32,39,44,45,47,49,50,55,57,58]; one utilised focus groups [60]; seven involved a combination of semistructured interviews and focus groups [34-38, 52, 56]; six were ethnographic studies [33,46,48,51,53,61]; and one used in-depth interviews [41]. The mixedmethods studies used varying combinations of semistructured interviews, focus groups, survey data, patient data, and narrative and systematic reviews of the literature [31,40,42,43].…”

“…Identification of where the intervention addressed potential implementation issues [31,37,41,49,50,53].…”

“…Refinement of intervention ahead of full trial [37,53]. "We have highlighted the use of Normalisation Process Theory to support development, and not just implementation, of a complex intervention" [48].…”

“…"We acknowledge that research teams found it difficult to answer some of the 16 sensitizing questions without knowing which stakeholders or sites were going to be involved with the implementation work" [53].…”

“…Articles identified Cognitive Participation as the extent to which participants bought into the intervention [33,34], engaged with it [33,37,38,44,53,56,58], and committed to it [32,37,56]. Collective Action related to the allocation of organisational and personal resources to interventions [32,34], how the intervention was operationalised [32-34, 37, 39, 58], and the definition of roles and responsibilities [34].…”