Research “push”, long term-change, and general practice

Abstract

If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation.*Related content and download information correct at time of download. Purpose -Intervention evaluations have not always accounted for long-term implementation of interventions. The purpose of this paper is to explore implementation of a primary care intervention during the lifespan of the trial and beyond. Design/methodology/approach -Eight general practices participated in the trial (four control and four intervention). In-depth interviews (with nine GPs and four practices nurses who delivered the intervention) and observation methods were employed. Thematic analysis was utilized and Normalization Process Theory (NPT) constructs were compared with emergent themes. Findings -Macro-level policy imperatives shaped practice priorities which resulted in the "whole system" new intervention not being perceived to be sustainable. Continued routinization of the intervention into usual care beyond the lifespan of the funded study was dependent on individualized monitoring and taking forward tacit knowledge.Research limitations/implications -The authors discuss the implications of these findings for sociological theories of implementation and understanding outcomes of research led complex interventions. Originality/value -The study describes the complex interplay between macro processes and individual situated practices and contributes to understanding if, how, and why interventions are sustained beyond initial "research push". The value of the study lies in describing the conditions and potential consequences of long-term implementation, which might be translated to other contexts.

A nurse-led clinic for patients consulting with osteoarthritis in general practice: development and impact of training in a cluster randomised controlled trial

“…This finding was also reflected in the post intervention group interview with the nurses, a component of the qualitative work within the MOSAICS study [43, 44]. In a group interview the nurses described how they felt more confident dealing with patients who consulted with OA and were able to modify their relationship with OA patients, because they had the opportunity to play more of an active role in patient care [43]. Ong et al [44] also reported that the nurses recognised that they had lacked skills and knowledge of OA previously, felt that the training had helped to up skill them in this regard, and left them feeling they could manage patients with OA better than previously, and boosted their professional standing.…”

“…This seems to be reflected in the clinical management, as it appears that the nurses focused on the core treatments of information provision, encouraging weight management and physical activity. This finding was also reflected in the post intervention group interview with the nurses, a component of the qualitative work within the MOSAICS study [43, 44]. In a group interview the nurses described how they felt more confident dealing with patients who consulted with OA and were able to modify their relationship with OA patients, because they had the opportunity to play more of an active role in patient care [43].…”

Sustaining an intervention for physical health promotion in community mental health services: A multisite case study

“…In our study, opportunities for reconfiguring the intervention activities-considered a subconstruct of reflexive monitoring in NPT-were important for sustainment, which is in correspondence with implementation studies using NPT (e.g., Pope, 2013) and with the wider literature on diffusion of innovations (Greenhalgh et al, 2008;Rogers, 2003 The significance of the social systems within which normalisation processes take place is also emphasised in recent theoretical developments of NPT (May et al, 2016). Similarly, in a NPT-inspired study of a complex intervention in primary care, Morden et al (2015) found the policy context to be critical for general practitioners' decisions if to continue a complex intervention after the trial ended.…”

“…The significance of the social systems within which normalisation processes take place is also emphasised in recent theoretical developments of NPT (May et al, ). Similarly, in a NPT‐inspired study of a complex intervention in primary care, Morden et al () found the policy context to be critical for general practitioners' decisions if to continue a complex intervention after the trial ended.…”

“…Our study employed Normalisation Process Theory (NPT) (May & Finch, ; May, Mair, Finch, & MacFarlane, ). NPT has been mainly used to analyse the implementation of health interventions (McEvoy et al, ), and there are few studies on sustainment (e.g., Morden et al, , Hooker, Small, & Taft,). This is surprising given that NPT was originally presented as concerned with making practices “routine elements of everyday life (embedding)” and with “sustaining embedded practices in their social contexts (integration)” (May & Finch, , p. 538).…”