- Academic Unit of General Practice & Primary Care
1 Horselethill Road
Glasgow G12 9LX - 00 44 141 330 8329
Kate O'Donnell
University of Glasgow, General Practice & Primary Care, Faculty Member
- Primary Health Care, Organisation and delivery of health services, Health Policy, Primary Care, Migrant Health, Implementation Science, and 30 moreFamily Medicine, Patient Safety, Public Health Policy, Culture, Ethnicity, State, Religion, Migration, Displacement, Oral Traditions, Gender, Borders and Borderlands, Minorities, Language politics, Refugees, Refugee memory, Organizational Change, Managing Change, Change Implementation, Multicultural, Change Resistance, Readiness for Change, Coping With Change, Communication, Involvement, Middle Management, Case Study, Change Factors, Intercultural Management, and Change agentsedit
- I am Professor of Primary Care Research & Development in the Academic Unit of General Practice & Primary Care, Univer... moreI am Professor of Primary Care Research & Development in the Academic Unit of General Practice & Primary Care, University of Glasgow.
I lead a programme of work concerned with the implementation and delivery of primary care services, particularly for marginalised and underserved populations, and the evaluation and routinisation of primary care policy & services into practice. Most of my work uses a mixed method approach and funded by the European Union, the Scottish Government, the Chief Scientist Office and the NIHR Service Delivery & Organisation Programme. I have a particular interest in the application of Normalisation Process Theory and candidacy to help us understand the findings and implications of my research to routine practice and policy development. As part of this work, I am currently exploring the idea of "prevention burden" for both patients and health care professionals.
Current research includes:
Partner in an EU FP7 collaborative project RESTORE - REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings. See http://www.fp7restore.eu/
Partner in an EU FP7 project INMINDD: Innovative, Midlife Intervention for Dementia Deterrence. See http://www.inmindd.eu
Understanding the role of primary care in the management of co-morbid obesity: a mixed methods programme. CSO Academic Training Fellowships.
Developing successful prevention programmes for migrant groups. MRC Pre-doctoral Training Programme, College of MVLS, University of Glasgow.
Co-applicant on a Scottish Government funded project - Evaluation of the Links Worker Programme in “Deep End” general practices in Glasgow.
AHRC/SRC knowledge exchange grant to support ethical interpreting in health care. A series of short films can be downloaded free at www.gla.ac.uk/ethicalinterpreting.
Underpinning much of the work is the use of Normalisation Process Theory, to help us understand why complex interventions do, or do not, become embedded into routine practice. For more information on NPT, visit http://www.normalizationprocess.org/
I am happy to discuss supervising postgraduate research students in these areas. Current PGR students have projects in migrant health; practitioner responses to obesity; patient safety; accreditation systems; and organisational change in primary care.
Follow me on Twitter odo_kateedit
BACKGROUND: Recently, the LIfestyle for BRAin health (LIBRA) index was developed to assess an individual's prevention potential for dementia. OBJECTIVE: We investigated the predictive validity of the LIBRA index for incident dementia in... more
BACKGROUND: Recently, the LIfestyle for BRAin health (LIBRA) index was developed to assess an individual's prevention potential for dementia. OBJECTIVE: We investigated the predictive validity of the LIBRA index for incident dementia in midlife, late life, and the oldest-old. METHODS: 9,387 non-demented individuals were recruited from the European population-based DESCRIPA study. An individual's LIBRA index was calculated solely based on modifiable risk factors: depression, diabetes, physical activity, hypertension, obesity, smoking, hypercholesterolemia, coronary heart disease, and mild/moderate alcohol use. Cox regression was used to test the predictive validity of LIBRA for dementia at follow-up (mean 7.2 y, range 1-16). RESULTS: In midlife (55-69 y, n = 3,256) and late life (70-79 y, n = 4,320), the risk for dementia increased with higher LIBRA scores. Individuals in the intermediate- and high-risk groups had a higher risk of dementia than those in the low-risk group. In the oldest-old (80-97 y, n = 1,811), higher LIBRA scores did not increase the risk for dementia. CONCLUSION: LIBRA might be a useful tool to identify individuals for primary prevention interventions of dementia in midlife, and maybe in late life, but not in the oldest-old.
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Background Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the... more
Background
Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts.
Methods
PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 – 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. ‘telemedicine’, ‘mobile applications’, ‘personal health record’, ‘social networking’). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results.
Results
Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health EnGagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature.
Conclusion
This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them.
Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts.
Methods
PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 – 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. ‘telemedicine’, ‘mobile applications’, ‘personal health record’, ‘social networking’). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results.
Results
Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health EnGagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature.
Conclusion
This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them.
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Introduction Patients and the public are beginning to use digital health tools to assist in managing chronic illness, support independent living and self-care, and remain connected to health and care providers. However, engaging with and... more
Introduction Patients and the public are beginning to use digital health tools to assist in managing chronic illness, support independent living and self-care, and remain connected to health and care providers. However, engaging with and enrolling in digital health interventions, such as telehealth systems, mobile health applications, patient portals and personal health records, in order to use them varies considerably. Many factors affect people's ability to engage with and sign up to digital health platforms.Objectives The primary aim is to identify the barriers and facilitators patients and the public experience to engagement and recruitment to digital health interventions. The secondary aim is to identify engagement and enrolment strategies, leading if possible to a taxonomy of such approaches, and a conceptual framework of digital health engagement and recruitment processes.Methods A systematic review of qualitative studies will be conducted by searching six databases: MEDLINE, CINAHL, PubMed, EMBASE, Scopus and the ACM Digital Library for papers published between 2000 and 2015. Titles and abstracts along with full-text papers will be screened by two independent reviewers against predetermined inclusion and exclusion criteria. A data extraction form will be used to provide details of the included studies. Quality assessment will be conducted using the Consolidated Criteria for Reporting Qualitative Research checklist. Any disagreements will be resolved through discussion with an independent third reviewer. Analysis will be guided by framework synthesis and informed by normalization process theory and burden of treatment theory, to aid conceptualisation of digital health engagement and recruitment processes.Discussion This systematic review of qualitative studies will explore factors affecting engagement and enrolment in digital health interventions. It will advance our understanding of readiness for digital health by examining the complex factors that affect patients’ and the public's ability to take part.Trial registration number CRD42015029846.
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Background The implementation of research findings is not a straightforward matter. There are substantive and recognised gaps in the process of translating research findings into practice and policy. In order to overcome some of these... more
Background
The implementation of research findings is not a straightforward matter. There are substantive and recognised gaps in the process of translating research findings into practice and policy. In order to overcome some of these translational difficulties, a number of strategies have been proposed for researchers. These include greater use of theoretical approaches in research focused on implementation, and use of a wider range of research methods appropriate to policy questions and the wider social context in which they are placed. However, questions remain about how to combine theory and method in implementation research. In this paper, we respond to these proposals.
Discussion
Focussing on a contemporary social theory, Normalisation Process Theory, and a participatory research methodology, Participatory Learning and Action, we discuss the potential of their combined use for implementation research. We note ways in which Normalisation Process Theory and Participatory Learning and Action are congruent and may therefore be used as heuristic devices to explore, better understand and support implementation. We also provide examples of their use in our own research programme about community involvement in primary healthcare.
Conclusions
Normalisation Process Theory alone has, to date, offered useful explanations for the success or otherwise of implementation projects post-implementation. We argue that Normalisation Process Theory can also be used to prospectively support implementation journeys. Furthermore, Normalisation Process Theory and Participatory Learning and Action can be used together so that interventions to support implementation work are devised and enacted with the expertise of key stakeholders. We propose that the specific combination of this theory and methodology possesses the potential, because of their combined heuristic force, to offer a more effective means of supporting implementation projects than either one might do on its own, and of providing deeper understandings of implementation contexts, rather than merely describing change.
The implementation of research findings is not a straightforward matter. There are substantive and recognised gaps in the process of translating research findings into practice and policy. In order to overcome some of these translational difficulties, a number of strategies have been proposed for researchers. These include greater use of theoretical approaches in research focused on implementation, and use of a wider range of research methods appropriate to policy questions and the wider social context in which they are placed. However, questions remain about how to combine theory and method in implementation research. In this paper, we respond to these proposals.
Discussion
Focussing on a contemporary social theory, Normalisation Process Theory, and a participatory research methodology, Participatory Learning and Action, we discuss the potential of their combined use for implementation research. We note ways in which Normalisation Process Theory and Participatory Learning and Action are congruent and may therefore be used as heuristic devices to explore, better understand and support implementation. We also provide examples of their use in our own research programme about community involvement in primary healthcare.
Conclusions
Normalisation Process Theory alone has, to date, offered useful explanations for the success or otherwise of implementation projects post-implementation. We argue that Normalisation Process Theory can also be used to prospectively support implementation journeys. Furthermore, Normalisation Process Theory and Participatory Learning and Action can be used together so that interventions to support implementation work are devised and enacted with the expertise of key stakeholders. We propose that the specific combination of this theory and methodology possesses the potential, because of their combined heuristic force, to offer a more effective means of supporting implementation projects than either one might do on its own, and of providing deeper understandings of implementation contexts, rather than merely describing change.
Research Interests:
Research Interests: Program Evaluation, Social Theory, Primary Care, Communication, Health Promotion, and 26 moreSocial Sciences, Organizational Change, Primary Health Care, Intercultural Management, Implementation Science, Social Determinants of Health, Health Policy, British medical history, Change agents, Humans, Program Development, Middle Management, Case Study, Readiness for Change, Randomised Controlled Trial, Implementation, Complex interventions, Multicultural, Managing Change, Involvement, Public health systems and services research, BMJ, Change Implementation, Change Resistance, Coping With Change, and Change Factors
Background. Guidelines and training initiatives (G/TIs) available to support communication in cross-cultural primary health care consultations are not routinely used. We need to understand more about levers and barriers to their... more
Background. Guidelines and training initiatives (G/TIs) available to support communication in cross-cultural primary health care consultations are not routinely used. We need to understand more about levers and barriers to their implementation and identify G/TIs likely to be successfully implemented in practice.
Objective. To report a mapping process used to identify G/TIs and to prospectively appraise their implementability, using Normalization Process Theory (NPT).
Methods. RESTORE is a 4-year EU FP-7 project. We used purposeful and network sampling to identify experts in statutory and non-statutory agencies across Austria, England, Greece, Ireland, Scotland and the Netherlands who recommended G/TI data from the grey literature. In addition, a peer review of literature was conducted in each country. Resulting data were collated using a standardized Protocol Mapping Document. G/TIs were identified for inclusion by (i) initial elimination of incomplete G/TI material; (ii) application of filtering criteria; and (iii) application of NPT.
Results. 20 G/TIs met selection criteria: 8 guidelines and 12 training initiatives. Most G/TIs were identified in the Netherlands (n = 7), followed by Ireland (n = 6) and England (n = 5). Fewer were identified in Scotland (n = 2), and none in Greece or Austria. The majority (n = 13) were generated without the inclusion of migrant service users. All 20 were prospectively appraised for potential implementability by applying NPT.
Conclusions. NPT is useful as a means of prospectively testing G/TIs for implementability. Results indicate a need to initiate meaningful engagement of migrants in the development of G/TIs. A European-based professional standard for development and assessment of cross-cultural communication resources is advised.
Objective. To report a mapping process used to identify G/TIs and to prospectively appraise their implementability, using Normalization Process Theory (NPT).
Methods. RESTORE is a 4-year EU FP-7 project. We used purposeful and network sampling to identify experts in statutory and non-statutory agencies across Austria, England, Greece, Ireland, Scotland and the Netherlands who recommended G/TI data from the grey literature. In addition, a peer review of literature was conducted in each country. Resulting data were collated using a standardized Protocol Mapping Document. G/TIs were identified for inclusion by (i) initial elimination of incomplete G/TI material; (ii) application of filtering criteria; and (iii) application of NPT.
Results. 20 G/TIs met selection criteria: 8 guidelines and 12 training initiatives. Most G/TIs were identified in the Netherlands (n = 7), followed by Ireland (n = 6) and England (n = 5). Fewer were identified in Scotland (n = 2), and none in Greece or Austria. The majority (n = 13) were generated without the inclusion of migrant service users. All 20 were prospectively appraised for potential implementability by applying NPT.
Conclusions. NPT is useful as a means of prospectively testing G/TIs for implementability. Results indicate a need to initiate meaningful engagement of migrants in the development of G/TIs. A European-based professional standard for development and assessment of cross-cultural communication resources is advised.
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Implementing consumer oriented digital health products and services at scale is challenging and a range of barriers to reaching and recruiting users to these types of solutions can be encountered. This paper describes the experience of... more
Implementing consumer oriented digital health products and services at scale is challenging and a range of barriers to reaching and recruiting users to these types of solutions can be encountered. This paper describes the experience of implementers with the rollout of the Delivering Assisted Living Lifestyles at Scale (dallas) programme. The findings are based on qualitative analysis of baseline and midpoint interviews and project documentation. Eight main themes emerged as key factors which hindered participation. These include how the dallas programme was designed and operationalised, constraints imposed by partnerships, technology, branding, and recruitment strategies, as well as challenges with the development cycle and organisational culture.
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Domestic abuse policy increasingly uses language which indicates that abuse is patterned according to structural factors. However, practicing according to these structural accounts of abuse is problematic because of the policy and... more
Domestic abuse policy increasingly uses language which indicates that abuse is patterned according to structural factors. However, practicing according to these structural accounts of abuse is problematic because of the policy and organisational contexts that practitioners work within and, we argue, because the implications of the structured nature of victims’ experiences is not fully understood by all practitioners.
We ask whether women's differential use and experiences of services with a remit to address abuse can be illuminated using two theoretical perspectives – ‘candidacy’ and intersectionality. We report the findings of a literature synthesis that investigates how these improve our understanding of women's help-seeking and service utilisation and of the responses that they receive. Both concepts were highly congruent with the literature and we conclude that, together, candidacy and intersectionality offer a means of enhancing knowledge of how the political becomes enacted in the personal. Embedding such knowledge within practice repertoires offers the potential to develop more nuanced structural understandings of women's experiences and constraints.
We ask whether women's differential use and experiences of services with a remit to address abuse can be illuminated using two theoretical perspectives – ‘candidacy’ and intersectionality. We report the findings of a literature synthesis that investigates how these improve our understanding of women's help-seeking and service utilisation and of the responses that they receive. Both concepts were highly congruent with the literature and we conclude that, together, candidacy and intersectionality offer a means of enhancing knowledge of how the political becomes enacted in the personal. Embedding such knowledge within practice repertoires offers the potential to develop more nuanced structural understandings of women's experiences and constraints.
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Background The ‘never event’ concept has been implemented in many acute hospital settings to help prevent serious patient safety incidents. Benefits include increasing awareness of highly important patient safety risks among the... more
Background The ‘never event’ concept has been implemented in many acute hospital settings to help prevent serious patient safety incidents. Benefits include increasing awareness of highly important patient safety risks among the healthcare workforce, promoting proactive implementation of preventive measures, and facilitating incident reporting.
Aim To develop a preliminary list of never events for general practice.
Design and setting Application of a range of consensus-building methods in Scottish and UK general practices.
Method A total of 345 general practice team members suggested potential never events. Next, ‘informed’ staff (n =15) developed criteria for defining never events and applied the criteria to create a list of candidate never events. Finally, UK primary care patient safety ‘experts’ (n = 17) reviewed, refined, and validated a preliminary list via a modified Delphi group and by completing a content validity index exercise.
Results There were 721 written suggestions received as potential never events. Thematic categorisation reduced this to 38. Five criteria specific to general practice were developed and applied to produce 11 candidate never events. The expert group endorsed a preliminary list of 10 items with a content validity index (CVI) score of >80%.
Conclusion A preliminary list of never events was developed for general practice through practitioner experience and consensus-building methods. This is an important first step to determine the potential value of the never event concept in this setting. It is now intended to undertake further testing of this preliminary list to assess its acceptability, feasibility, and potential usefulness as a safety improvement intervention.
Aim To develop a preliminary list of never events for general practice.
Design and setting Application of a range of consensus-building methods in Scottish and UK general practices.
Method A total of 345 general practice team members suggested potential never events. Next, ‘informed’ staff (n =15) developed criteria for defining never events and applied the criteria to create a list of candidate never events. Finally, UK primary care patient safety ‘experts’ (n = 17) reviewed, refined, and validated a preliminary list via a modified Delphi group and by completing a content validity index exercise.
Results There were 721 written suggestions received as potential never events. Thematic categorisation reduced this to 38. Five criteria specific to general practice were developed and applied to produce 11 candidate never events. The expert group endorsed a preliminary list of 10 items with a content validity index (CVI) score of >80%.
Conclusion A preliminary list of never events was developed for general practice through practitioner experience and consensus-building methods. This is an important first step to determine the potential value of the never event concept in this setting. It is now intended to undertake further testing of this preliminary list to assess its acceptability, feasibility, and potential usefulness as a safety improvement intervention.
Research Interests: Health Sciences, Primary Care, General Practice, Quality Management, Primary Health Care, and 19 morePatient Safety, Family Medicine, Health Care, Health Care Policy, Implementation Science, Quality Improvement, Health, Health Services Research, Quality of Healthcare Services, General Practice and Health, Health Services, Audit, Quality and patient safety, Health Science, Consensus Decision-Making, Implementation, Total Quality Managment, Family and Community Medicine, and Change Implementation
BACKGROUND:There is a well-recognized need for greater use of theory to address research translational gaps. Normalization Process Theory (NPT) provides a set of sociological tools to understand and explain the social processes through... more
BACKGROUND:There is a well-recognized need for greater use of theory to address research translational gaps. Normalization Process Theory (NPT) provides a set of sociological tools to understand and explain the social processes through which new or modified practices of thinking, enacting, and organizing work are implemented, embedded, and integrated in healthcare and other organizational settings. This review of NPT offers readers the opportunity to observe how, and in what areas, a particular theoretical approach to implementation is being used. In this article we review the literature on NPT in order to understand what interventions NPT is being used to analyze, how NPT is being operationalized, and the reported benefits, if any, of using NPT.
METHODS:Using a framework analysis approach, we conducted a qualitative systematic review of peer-reviewed literature using NPT. We searched 12 electronic databases and all citations linked to six key NPT development papers. Grey literature/unpublished studies were not sought. Limitations of English language, healthcare setting and year of publication 2006 to June 2012 were set.
RESULTS:Twenty-nine articles met the inclusion criteria; in the main, NPT is being applied to qualitatively analyze a diverse range of complex interventions, many beyond its original field of e-health and telehealth. The NPT constructs have high stability across settings and, notwithstanding challenges in applying NPT in terms of managing overlaps between constructs, there is evidence that it is a beneficial heuristic device to explain and guide implementation processes.
CONCLUSIONS:NPT offers a generalizable framework that can be applied across contexts with opportunities for incremental knowledge gain over time and an explicit framework for analysis, which can explain and potentially shape implementation processes. This is the first review of NPT in use and it generates an impetus for further and extended use of NPT. We recommend that in future NPT research, authors should explicate their rationale for choosing NPT as their theoretical framework and, where possible, involve multiple stakeholders including service users to enable analysis of implementation from a range of perspectives.
METHODS:Using a framework analysis approach, we conducted a qualitative systematic review of peer-reviewed literature using NPT. We searched 12 electronic databases and all citations linked to six key NPT development papers. Grey literature/unpublished studies were not sought. Limitations of English language, healthcare setting and year of publication 2006 to June 2012 were set.
RESULTS:Twenty-nine articles met the inclusion criteria; in the main, NPT is being applied to qualitatively analyze a diverse range of complex interventions, many beyond its original field of e-health and telehealth. The NPT constructs have high stability across settings and, notwithstanding challenges in applying NPT in terms of managing overlaps between constructs, there is evidence that it is a beneficial heuristic device to explain and guide implementation processes.
CONCLUSIONS:NPT offers a generalizable framework that can be applied across contexts with opportunities for incremental knowledge gain over time and an explicit framework for analysis, which can explain and potentially shape implementation processes. This is the first review of NPT in use and it generates an impetus for further and extended use of NPT. We recommend that in future NPT research, authors should explicate their rationale for choosing NPT as their theoretical framework and, where possible, involve multiple stakeholders including service users to enable analysis of implementation from a range of perspectives.
Research Interests: Sociology, Health Sciences, Primary Care, Social Policy, Social Sciences, and 13 morePrimary Health Care, Normalisation Process Theory, Family Medicine, Implementation Science, Quality Improvement, Health Services Research, Health Systems, Systematic Reviews, Health Services, Normalization, Health Science, Implementation, and Change Implementation
Background: This is a time of unprecedented mobility across the globe. Healthcare systems need to adapt to ensure that primary care is culturally and linguistically appropriate for migrants. Evidence-based guidelines and training... more
Background: This is a time of unprecedented mobility across the globe. Healthcare systems need to adapt to ensure that primary care is culturally and linguistically appropriate for migrants. Evidence-based guidelines and training interventions for cultural competence and the use of professional interpreters are available across European healthcare settings. However, in real-world practice migrants and their healthcare providers ‘get by’ with a range of informal and inadequate strategies. RESTORE is an EU FP7 funded project, which is designed to address this translational gap.
Objectives: The objective of RESTORE is to investigate and support the implementation of guidelines and training initiatives to support communication in cross-cultural consultations in selected European primary care settings.
Design: RESTORE is a qualitative, participatory health project running from 2011–2015. It uses a novel combination of normalization process theory and participatory learning and action research to follow and shape the implementation journeys of relevant guidelines and training initiatives. Research teams in Ireland, England, the Netherlands, Austria and Greece are conducting similar parallel qualitative case study fieldwork, with a complementary health policy analysis led by Scotland. In each setting, key stakeholders, including migrants, are involved in participatory data generation and analysis.
Expected results: RESTORE will provide knowledge about the levers and barriers to the implementation of guidelines and training initiatives in European healthcare settings and about successful, transferrable strategies to overcome identified barriers. RESTORE will elucidate the role of policy in shaping these implementation journeys; generate recommendations for European policy driving the development of culturally and linguistically appropriate healthcare systems.
Objectives: The objective of RESTORE is to investigate and support the implementation of guidelines and training initiatives to support communication in cross-cultural consultations in selected European primary care settings.
Design: RESTORE is a qualitative, participatory health project running from 2011–2015. It uses a novel combination of normalization process theory and participatory learning and action research to follow and shape the implementation journeys of relevant guidelines and training initiatives. Research teams in Ireland, England, the Netherlands, Austria and Greece are conducting similar parallel qualitative case study fieldwork, with a complementary health policy analysis led by Scotland. In each setting, key stakeholders, including migrants, are involved in participatory data generation and analysis.
Expected results: RESTORE will provide knowledge about the levers and barriers to the implementation of guidelines and training initiatives in European healthcare settings and about successful, transferrable strategies to overcome identified barriers. RESTORE will elucidate the role of policy in shaping these implementation journeys; generate recommendations for European policy driving the development of culturally and linguistically appropriate healthcare systems.
Research Interests:
Here, we describe the impact that austerity measures are having on migrants' access to health care in Europe.
Research Interests: Health Sciences, Primary Care, Communication, Multiculturalism, Intercultural Communication, and 20 morePrimary Health Care, Family Medicine, Health Inequalities, Migration, Global Health, Race and Ethnicity, Health Disparities, Migration Studies, Migrant Health, Public Health, Health Policy, Migrant health Policies, Global Health Policy, Ethnicity, Public Health Systems & Services Research, Health Systems, Health Services, Health Science, Access to Health Care, and Family and Community Medicine
The development of a high-quality primary healthcare system requires multidisciplinary perspectives and collaborations between clinicians and non-clinicians. Academic primary care departments across the United Kingdom and Ireland employ... more
The development of a high-quality primary healthcare system requires multidisciplinary perspectives and collaborations between clinicians and non-clinicians. Academic primary care departments across the United Kingdom and Ireland employ academics from a range of disciplines. However, questions remain about the parity of opportunity for career progression with a consistent trend to focus more on clinicians than non-clinicians. In this paper, we analyse the employment and careers of non-clinical primary care academics working in Ireland and Scotland. We draw on survey data from the island of Ireland and conference workshop discussions among Irish- and Scottish-based academics. We highlight problems with career progression and identify some strategic actions. We argue for a renewed attempt to ensure that all academics who are contributing to the discipline of primary care are appropriately acknowledged and supported to continue their endeavours to develop high-quality primary care health systems.(Received February 10 2012)(Revised September 29 2012)(Accepted October 05 2012)(Online publication February 04 2013)
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BACKGROUND:Estimating harm rates for specific patient populations and detecting significant changes in them over time are essential if patient safety in general practice is to be improved. Clinical record review (CRR) is arguably the most... more
BACKGROUND:Estimating harm rates for specific patient populations and detecting significant changes in them over time are essential if patient safety in general practice is to be improved. Clinical record review (CRR) is arguably the most suitable method for these purposes, but the optimal values and combinations of its parameters (such as numbers of records and practices) remain unknown. Our aims were to: 1. Determine and quantify CRR parameters; 2. Assess the precision and power of feasible CRR scenarios; and 3. Quantify the minimum requirements for adequate precision and acceptable power.
METHOD:We explored precision and power of CRR scenarios using Monte Carlo simulation. A range of parameter values were combined in 864 different CRR scenarios, with 1000 random data sets generated for each, and harm rates were estimated and tested for change over time by fitting a generalised linear model with a Poisson response.
RESULTS:CRR scenarios with [greater than or equal to]100 detected harm incidents had harm rate estimates with acceptable precision. Harm reductions of 20% or [greater than or equal to]50% were detected with adequate power by those CRR scenarios with at least 100 and 500 harm incidents respectively. The number of detected harm incidents was dependent on the baseline harm rate multiplied by: the period of time reviewed in each record; number of records reviewed per practice; number of practices who reviewed records; and the number of times each record was reviewed.
CONCLUSION:We developed a simple formula to calculate the minimum values of CRR parameters required to achieve adequate precision and acceptable power when monitoring harm rates. Our findings have practical implications for health care decision-makers, leaders and researchers aiming to measure and reduce harm at regional or national level.
METHOD:We explored precision and power of CRR scenarios using Monte Carlo simulation. A range of parameter values were combined in 864 different CRR scenarios, with 1000 random data sets generated for each, and harm rates were estimated and tested for change over time by fitting a generalised linear model with a Poisson response.
RESULTS:CRR scenarios with [greater than or equal to]100 detected harm incidents had harm rate estimates with acceptable precision. Harm reductions of 20% or [greater than or equal to]50% were detected with adequate power by those CRR scenarios with at least 100 and 500 harm incidents respectively. The number of detected harm incidents was dependent on the baseline harm rate multiplied by: the period of time reviewed in each record; number of records reviewed per practice; number of practices who reviewed records; and the number of times each record was reviewed.
CONCLUSION:We developed a simple formula to calculate the minimum values of CRR parameters required to achieve adequate precision and acceptable power when monitoring harm rates. Our findings have practical implications for health care decision-makers, leaders and researchers aiming to measure and reduce harm at regional or national level.
Research Interests: Health Sciences, Primary Care, General Practice, Statistics, Organizational Change, and 26 moreQuality Management, Primary Health Care, Biostatistics, Patient Safety, Family Medicine, Implementation Science, Quality Improvement, Quantitative Research, Quantitative Methods, Public Health, Health Services Research, Health Policy, Quality of Healthcare Services, Total Quality Management (TQM), General Practice and Health, Health Services, Quality and patient safety, Family Medicine39 followersx, Primary Health Care137 followersx, General Practice, Readiness for Change, Implementation, Managing Change, Family and Community Medicine, Change Implementation, Change Resistance, Coping With Change, and Change Factors
The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health... more
The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services. It is well established that there is a need for skilled interpreters and for professionals who are culturally competent to address this problem. A range of professional guidelines and training initiatives exist that support the communication in cross-cultural consultations in primary care. However, these are commonly not implemented in daily practice. It is as yet unknown why professionals do not accept or implement these guidelines and interventions, or under what circumstances they would do so. A new study involving six European countries, RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings), aims to address these gaps in knowledge. It uses a unique combination of a contemporary social theory, normalisation process theory (NPT) and participatory learning and action (PLA) research. This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions.(Received April 15 2012)(Revised February 27 2013)(Accepted March 10 2013)
Research Interests: Social Change, Social Theory, Demography, Health Sciences, Primary Care, and 60 moreGeneral Practice, Communication, Statistics, Intercultural Communication, Social Policy, Health Communication, Health Promotion, Epidemiology, Social epidemiology, Social Networks, Social Sciences, Organizational Change, Primary Health Care, Qualitative methodology, Intercultural Management, Stigma, Family Medicine, Primary Care (Policy Studies), Medical Education, Health Inequalities, Migration, Global Health, Race and Ethnicity, Social Justice, Implementation Science, Public Health Policy, Health Disparities, Qualitative Research, Social Exclusion, Migrant Health, Public Health, Health Services Research, Health Policy, Quality of Healthcare Services, Culture and Communication, Community Participation, Ethnicity, Social Inequality, Communication in Healthcare, Change agents, Health Services, Case Study, Quality and patient safety, Health Science, Readiness for Change, Evaluation the Quality of Services in the Primary Health Care, Implementation, Multicultural, Family Medicine, Medical Education, Communication in Health care, Managing Change, Involvement, Family and Community Medicine, Power and Empowerment, Highly Skilled Migrants, Intra EU Migration, Gender and Family Migration, Change Implementation, Change Resistance, and Change Factors
Background. African migrants to the West are at increased risk of hypertensive related diseases and certain cancers compared with other ethnic groups. Little is known about their awareness of this risk or knowledge of associated risk... more
Background. African migrants to the West are at increased risk of hypertensive related diseases and certain cancers compared with other ethnic groups. Little is known about their awareness of this risk or knowledge of associated risk factors.
Objectives. To explore African migrants' perceptions of chronic disease risk, risk factors and underlying explanatory models.
Design. In-depth interviews with 19 Africans from French- or Swahili-speaking countries living in Glasgow were conducted. Interviews were transcribed and 10 translated (3 Swahili and 7 French). Analysis was informed by a grounded theory approach.
Results. Narratives suggested low awareness of chronic disease risk among participants. Africans reported a positive outlook on life that discouraged thought about future sickness. Infectious diseases were considered the dominant health threat for African migrants, mainly HIV but also TB and ‘flu’. Chronic diseases were sometimes described as contagious. Explanatory models of chronic disease included bodily/dietary imbalance, stress/exertion, heredity/predisposition and food contamination. Cancer was feared but not considered a major threat. Cancer was considered more common in Europe than Africa and attributed to chemical contamination from fertilisers, food preservatives and industrial pollution. Evidence cited for these chemicals was rapid livestock/vegetable production, large size of livestock (e.g., fish), softness of meat and flavourless food. Chemicals were reported to circulate silently inside the body and cancer to form in the part where they deposit, sometimes years later. Cardiovascular diseases were described in terms of acute symptoms that required short-term medication. Confidentiality concerns were reported to prevent discussion of chronic disease between Africans.
Conclusion. This study suggests a need to improve chronic disease health literacy among African migrants to promote engagement with preventive behaviours. This should build on not only participants’ existing knowledge of disease causation and risk factors but also their self-reliance in the pursuit of a healthy lifestyle and desire to retain cultural knowledge and practice.
Objectives. To explore African migrants' perceptions of chronic disease risk, risk factors and underlying explanatory models.
Design. In-depth interviews with 19 Africans from French- or Swahili-speaking countries living in Glasgow were conducted. Interviews were transcribed and 10 translated (3 Swahili and 7 French). Analysis was informed by a grounded theory approach.
Results. Narratives suggested low awareness of chronic disease risk among participants. Africans reported a positive outlook on life that discouraged thought about future sickness. Infectious diseases were considered the dominant health threat for African migrants, mainly HIV but also TB and ‘flu’. Chronic diseases were sometimes described as contagious. Explanatory models of chronic disease included bodily/dietary imbalance, stress/exertion, heredity/predisposition and food contamination. Cancer was feared but not considered a major threat. Cancer was considered more common in Europe than Africa and attributed to chemical contamination from fertilisers, food preservatives and industrial pollution. Evidence cited for these chemicals was rapid livestock/vegetable production, large size of livestock (e.g., fish), softness of meat and flavourless food. Chemicals were reported to circulate silently inside the body and cancer to form in the part where they deposit, sometimes years later. Cardiovascular diseases were described in terms of acute symptoms that required short-term medication. Confidentiality concerns were reported to prevent discussion of chronic disease between Africans.
Conclusion. This study suggests a need to improve chronic disease health literacy among African migrants to promote engagement with preventive behaviours. This should build on not only participants’ existing knowledge of disease causation and risk factors but also their self-reliance in the pursuit of a healthy lifestyle and desire to retain cultural knowledge and practice.
Research Interests: Religion, Social Theory, Primary Care, General Practice, Communication, and 41 moreIntercultural Communication, Health Communication, Health Promotion, Social Sciences, Violence, Primary Health Care, Qualitative methodology, Family Medicine, Primary Care (Policy Studies), Health Inequalities, Migration, Faculty Development, Gender, Culture, Health Disparities, Oral Traditions, Qualitative Research, Migrant Health, Public Health, Health Policy, Culture and Communication, Qualitative Research Methods, Ethnicity, Refugees, Cultural change, Minorities, Digital Anthropologies, Health beliefs & behaviour, Language politics, State, Migration and Diaspora, Displacement, Borders and Borderlands, Knowledge Practices, Communication in Health care, Human Rights/legal Anthropology, Family and Community Medicine, Health Promotion and Education, Refugee memory, Ethnic and 'Non ethnic' Identities, and Anthropological Debates
"Background The implementation of guidelines and training initiatives to support communication in crosscultural primary care consultations is ad hoc across a range of international settings with a range of negative consequences... more
"Background
The implementation of guidelines and training initiatives to support communication in crosscultural primary care consultations is ad hoc across a range of international settings with a range of negative consequences particularly for migrants. This situation reflects a welldocumented translational gap between evidence and practice and is part of the wider problem of implementing guidelines and the broader range of professional educational and quality interventions in routine practice. In this paper, we describe our use of a contemporary social theory, Normalization Process Theory and participatory research methodology--Participatory Learning and Action--to investigate and support implementation of such guidelines and training initiatives in routine practice.
Methods
This is a qualitative case study, using multiple primary care sites across Europe. Purposive and maximum variation sampling approaches will be used to identify and recruit stakeholders--migrant service users, general practitioners, primary care nurses, practice managers and administrative staff, interpreters, cultural mediators, service planners, and policy makers. We are conducting a mapping exercise to identify relevant guidelines and training initiatives. We will then initiate a PLA-brokered dialogue with stakeholders around Normalization Process Theory's four constructs--coherence, cognitive participation, collective action, and reflexive monitoring. Through this, we will enable stakeholders in each setting to select a single guideline or training initiative for implementation in their local setting. We will prospectively investigate and support the implementation journeys for the five selected interventions. Data will be generated using a Participatory Learning and Action approach to interviews and focus groups. Data analysis will follow the principles of thematic analysis, will occur in iterative cycles throughout the project and will involve participatory co-analysis with key stakeholders to enhance the authenticity and veracity of findings.
Discussion
This research employs a unique combination of Normalization Process Theory and Participatory Learning and Action, which will provide a novel approach to the analysis of implementation journeys. The findings will advance knowledge in the field of implementation science because we are using and testing theoretical and methodological approaches so that we can critically appraise their scope to mediate barriers and improve the implementation processes.
"
The implementation of guidelines and training initiatives to support communication in crosscultural primary care consultations is ad hoc across a range of international settings with a range of negative consequences particularly for migrants. This situation reflects a welldocumented translational gap between evidence and practice and is part of the wider problem of implementing guidelines and the broader range of professional educational and quality interventions in routine practice. In this paper, we describe our use of a contemporary social theory, Normalization Process Theory and participatory research methodology--Participatory Learning and Action--to investigate and support implementation of such guidelines and training initiatives in routine practice.
Methods
This is a qualitative case study, using multiple primary care sites across Europe. Purposive and maximum variation sampling approaches will be used to identify and recruit stakeholders--migrant service users, general practitioners, primary care nurses, practice managers and administrative staff, interpreters, cultural mediators, service planners, and policy makers. We are conducting a mapping exercise to identify relevant guidelines and training initiatives. We will then initiate a PLA-brokered dialogue with stakeholders around Normalization Process Theory's four constructs--coherence, cognitive participation, collective action, and reflexive monitoring. Through this, we will enable stakeholders in each setting to select a single guideline or training initiative for implementation in their local setting. We will prospectively investigate and support the implementation journeys for the five selected interventions. Data will be generated using a Participatory Learning and Action approach to interviews and focus groups. Data analysis will follow the principles of thematic analysis, will occur in iterative cycles throughout the project and will involve participatory co-analysis with key stakeholders to enhance the authenticity and veracity of findings.
Discussion
This research employs a unique combination of Normalization Process Theory and Participatory Learning and Action, which will provide a novel approach to the analysis of implementation journeys. The findings will advance knowledge in the field of implementation science because we are using and testing theoretical and methodological approaches so that we can critically appraise their scope to mediate barriers and improve the implementation processes.
"
Research Interests: Social Theory, Health Sciences, Primary Care, Communication, Intercultural Communication, and 57 moreSocial Policy, Health Communication, Social Sciences, Organizational Change, Primary Health Care, Qualitative methodology, Intercultural Management, Health inequality, Family Medicine, Primary Care (Policy Studies), Health Inequalities, Migration, Race and Ethnicity, Social Justice, Implementation Science, Public Health Policy, Gender, Culture, Health Disparities, Oral Traditions, Qualitative Research, Migration Studies, Migrant Health, Public Health, Sociology of Migration, Transnational migration, Health Services Research, Health Policy, Quality of Healthcare Services, Culture and Communication, Migrant health Policies, Ethnicity, Refugees, Minorities, Change agents, Language politics, State, Middle Management, Case Study, Quality and patient safety, Health Science, Displacement, Readiness for Change, Implementation, Multicultural, Borders and Borderlands, Family Medicine, Medical Education, Managing Change, Health Disparaties, Involvement, Family and Community Medicine, Refugee memory, Change Implementation, Change Resistance, Coping With Change, Change Factors, and Public Policy
BACKGROUND:The major problem facing health and social care systems globally today is the growing challenge of an elderly population with complex health and social care needs. A longstanding challenge to the provision of high quality,... more
BACKGROUND:The major problem facing health and social care systems globally today is the growing challenge of an elderly population with complex health and social care needs. A longstanding challenge to the provision of high quality, effectively coordinated care for those with complex needs has been the historical separation of health and social care. Access to timely and accurate data about patients and their treatments has the potential to deliver better care at less cost.
METHODS:To explore the way in which structural, professional and geographical boundaries have affected e-health implementation in health and social care, through an empirical study of the implementation of an electronic version of Single Shared Assessment (SSA) in Scotland, using three retrospective, qualitative case studies in three different health board locations.
RESULTS:Progress in effectively sharing electronic data had been slow and uneven. One cause was the presence of established structural boundaries, which lead to competing priorities, incompatible IT systems and infrastructure, and poor cooperation. A second cause was the presence of established professional boundaries, which affect staffs understanding and acceptance of data sharing and their information requirements. Geographical boundaries featured but less prominently and contrasting perspectives were found with regard to issues such as co-location of health and social care professionals.
CONCLUSIONS:To provide holistic care to those with complex health and social care needs, it is essential that we develop integrated approaches to care delivery. Successful integration needs practices such as good project management and governance, ensuring system interoperability, leadership, good training and support, together with clear efforts to improve working relations across professional boundaries and communication of a clear project vision. This study shows that while technological developments make integration possible, long-standing boundaries constitute substantial risks to IT implementations across the health and social care interface which those initiating major changes would do well to consider before committing to the investment
METHODS:To explore the way in which structural, professional and geographical boundaries have affected e-health implementation in health and social care, through an empirical study of the implementation of an electronic version of Single Shared Assessment (SSA) in Scotland, using three retrospective, qualitative case studies in three different health board locations.
RESULTS:Progress in effectively sharing electronic data had been slow and uneven. One cause was the presence of established structural boundaries, which lead to competing priorities, incompatible IT systems and infrastructure, and poor cooperation. A second cause was the presence of established professional boundaries, which affect staffs understanding and acceptance of data sharing and their information requirements. Geographical boundaries featured but less prominently and contrasting perspectives were found with regard to issues such as co-location of health and social care professionals.
CONCLUSIONS:To provide holistic care to those with complex health and social care needs, it is essential that we develop integrated approaches to care delivery. Successful integration needs practices such as good project management and governance, ensuring system interoperability, leadership, good training and support, together with clear efforts to improve working relations across professional boundaries and communication of a clear project vision. This study shows that while technological developments make integration possible, long-standing boundaries constitute substantial risks to IT implementations across the health and social care interface which those initiating major changes would do well to consider before committing to the investment
Research Interests: Social Theory, Primary Care, Social Sciences, Organizational Change, Primary Health Care, and 17 moreQualitative methodology, Qualitative Methods, Health Care, Implementation Science, Social Care, Qualitative Health Research, Qualitative Research, Health Services Research, Quality of Healthcare Services, Qualitative Research Methodology, Health Systems, Health Services, Health and Social Care, Implementation, Implementation Research, Health Care Systems, and Integrated Care
Major policy initiatives such as the Quality and Outcomes Framework (QOF) in the national contract for UK general practitioners might variably be informed by evidence at their inception, implementation and subsequent evolution. But what... more
Major policy initiatives such as the Quality and Outcomes Framework (QOF) in the national contract for UK general practitioners might variably be informed by evidence at their inception, implementation and subsequent evolution. But what evidence gets admitted into these policy debates—and what is left out? Using QOF as an example, this article demonstrates what an analysis of the relationship between policy and the associated research can tell us about the underlying policy assumptions and about the role of evidence in policy debates.
Research Interests: Primary Care, Communication, Organizational Change, Primary Health Care, Intercultural Management, and 18 moreFamily Medicine, Health Care, Implementation Science, Public Health Policy, Health Policy, Quality of Healthcare Services, Health Care Management, Change agents, Middle Management, Case Study, Readiness for Change, Multicultural, Managing Change, Involvement, Change Implementation, Change Resistance, Coping With Change, and Change Factors
Across the public sector there is concern that service uptake is inequitably distributed by socio-economic circumstances and that public provision exacerbates the existence of inequalities either because services are not allocated by need... more
Across the public sector there is concern that service uptake is inequitably distributed by socio-economic circumstances and that public provision exacerbates the existence of inequalities either because services are not allocated by need or because of differential patterns of uptake between the most and least affluent groups.
A concept that offers potential to understand access and utilization is ‘candidacy’ which has been used to explain access to, and utilization of, healthcare. The concept suggests that an individual's identification of his or her ‘candidacy’ for health services is structurally, culturally, organizationally and professionally constructed, and helps to explain why those in deprived circumstances make less use of services than the more affluent.
In this article we assess the fit of candidacy to other public services using a Critical Interpretive Synthesis of three case studies literatures relating to: domestic abuse, higher education and environmental services.
We find high levels of congruence between ‘candidacy’ and the sampled literatures on access/utilization of services. We find, however, that the concept needs to be refined. In particular, we distinguish between micro, meso and macro factors that play into the identification, sustaining and resolution of candidacy, and demonstrate the plural nature of candidacies. We argue that this refined model of candidacy should be tested empirically beyond and within health. More specifically, in the current economic context, we suggest that it becomes imperative to better understand how access to public services is influenced by multiple factors including changing discourses of deservedness and fairness, and by stringent reductions in the public purse.
A concept that offers potential to understand access and utilization is ‘candidacy’ which has been used to explain access to, and utilization of, healthcare. The concept suggests that an individual's identification of his or her ‘candidacy’ for health services is structurally, culturally, organizationally and professionally constructed, and helps to explain why those in deprived circumstances make less use of services than the more affluent.
In this article we assess the fit of candidacy to other public services using a Critical Interpretive Synthesis of three case studies literatures relating to: domestic abuse, higher education and environmental services.
We find high levels of congruence between ‘candidacy’ and the sampled literatures on access/utilization of services. We find, however, that the concept needs to be refined. In particular, we distinguish between micro, meso and macro factors that play into the identification, sustaining and resolution of candidacy, and demonstrate the plural nature of candidacies. We argue that this refined model of candidacy should be tested empirically beyond and within health. More specifically, in the current economic context, we suggest that it becomes imperative to better understand how access to public services is influenced by multiple factors including changing discourses of deservedness and fairness, and by stringent reductions in the public purse.
Research Interests: Social Theory, Health Sciences, Primary Care, Communication, Social Policy, and 31 moreHealth Promotion, Social Sciences, Organizational Change, Narrative, Primary Health Care, Qualitative methodology, Intercultural Management, Family Medicine, Health Inequalities, Public Health Policy, Social Determinants of Health, Health Disparities, Qualitative Health Research, Public Health, Health Services Research, Health Policy, Change agents, Socilogy, Patient Experiences, Middle Management, Case Study, Health Science, Readiness for Change, Narrative synthesis, Multicultural, Managing Change, Involvement, Change Implementation, Change Resistance, Coping With Change, and Change Factors
Research Interests: Health Psychology, Health Sciences, Primary Care, Social Research Methods and Methodology, Research Methodology, and 21 moreDesign Methods, Normalization Process Theory, Normalisation Process Theory, Qualitative Research, Quantitative Methods, Public Health, Health Services Research, E Health, Chronic illness, Telemedicine, Public Health Systems & Services Research, Primary, Humans, eHealth, Medical Technology, Secondary, Diffusion of Innovation, Computer User Interface Design, Public health systems and services research, Tertiary care, and Healthcare Infrastructure
ObjectiveTo systematically review the literature on the implementation of e-health to identify: (i) barriers and facilitators to e-health implementation, and (ii) outstanding gaps in research on the subject.MethodsMEDLINE, EMBASE, CINAHL,... more
ObjectiveTo systematically review the literature on the implementation of e-health to identify: (i) barriers and facilitators to e-health implementation, and (ii) outstanding gaps in research on the subject.MethodsMEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health implementation. Abstracts and papers were double screened and data were extracted on country of origin; e-health domain; publication date; aims and methods; databases searched; inclusion and exclusion criteria and number of papers included. Data were analysed qualitatively using normalization process theory as an explanatory coding framework.FindingsInclusion criteria were met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009. Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13 did not indicate the precise number of articles screened. The use of normalization process theory as a conceptual framework revealed that relatively little attention was paid to: (i) work directed at making sense of e-health systems, specifying their purposes and benefits, establishing their value to users and planning their implementation; (ii) factors promoting or inhibiting engagement and participation; (iii) effects on roles and responsibilities; (iv) risk management, and (v) ways in which implementation processes might be reconfigured by user-produced knowledge.ConclusionThe published literature focused on organizational issues, neglecting the wider social framework that must be considered when introducing new technologies.
Research Interests: Social Theory, Health Sciences, Primary Care, Communication, Social Sciences, and 34 moreOrganizational Change, Primary Health Care, Intercultural Management, Family Medicine, Health Care Policy, Global Health, Implementation Science, Meta-Analysis and Systematic Review, Telehealth, Public Health, Health Services Research, Health Policy, Global Health Policy, Telemedicine, Change agents, eHealth, Global Public Health, Health Services, Middle Management, Case Study, Health Science, eHealth, health informatics, Healthcare Technology, Readiness for Change, Implementation, Multicultural, Telehealth and eHealth, Managing Change, Involvement, Family and Community Medicine, mHealth and eHealth, Change Implementation, Change Resistance, Coping With Change, and Change Factors
""Background: Primary prevention often occurs against a background of inequalities in health and health care. Addressing this requires practitioners and systems to acknowledge the contribution of health-related and social determinants and... more
""Background: Primary prevention often occurs against a background of inequalities in health and health care. Addressing this requires practitioners and systems to acknowledge the contribution of health-related and social determinants and to deal with the lack of interconnectedness between health and social service providers. Recognising this, the Scottish Government has implemented a national programme of anticipatory care targeting individuals aged 45-64 years living in areas of socioeconomic deprivation and at high risk of cardiovascular disease. This programme is called Keep Well.
Aim: To explore the issues and tensions underpinning the implementation of a national programme of anticipatory care.
Design and setting: A qualitative study in five Wave 1 Keep Well pilot sites, located in urban areas of Scotland, and involving 79 general practices.
Method: Annual semi-structured interviews were conducted with 74 key stakeholders operating at national government level, local pilot level and within general practices, resulting in 118 interviews. Interview transcripts were analysed using the framework approach.
Results: Four underlying tensions were identified. First, those between a patient-focused general-practice approach versus a population-level health-improvement approach, linking disparate health and social services; secondly, medical approaches versus wider social approaches; thirdly, a population-wide approach versus individual targeting; and finally, reactive versus anticipatory care.
Conclusion: Implementing an anticipatory care programme to address inequalities in cardiovascular disease identified several tensions, which need to be understood and resolved in order to inform the development of such approaches in general practice and to develop systems that reduce the degree of fragmentation across health and social services""
Aim: To explore the issues and tensions underpinning the implementation of a national programme of anticipatory care.
Design and setting: A qualitative study in five Wave 1 Keep Well pilot sites, located in urban areas of Scotland, and involving 79 general practices.
Method: Annual semi-structured interviews were conducted with 74 key stakeholders operating at national government level, local pilot level and within general practices, resulting in 118 interviews. Interview transcripts were analysed using the framework approach.
Results: Four underlying tensions were identified. First, those between a patient-focused general-practice approach versus a population-level health-improvement approach, linking disparate health and social services; secondly, medical approaches versus wider social approaches; thirdly, a population-wide approach versus individual targeting; and finally, reactive versus anticipatory care.
Conclusion: Implementing an anticipatory care programme to address inequalities in cardiovascular disease identified several tensions, which need to be understood and resolved in order to inform the development of such approaches in general practice and to develop systems that reduce the degree of fragmentation across health and social services""
Research Interests: Health Sciences, Primary Care, General Practice, Health Promotion, Social Sciences, and 28 morePrimary Health Care, Qualitative methodology, Organisational Change, Qualitative Research (Health Sciences), Family Medicine, Health Care Policy, Health Inequalities, Implementation Science, Social Determinants of Health, Health Disparities, Qualitative Health Research, Qualitative Research, Health, Health Services Research, Health Policy, Health Care Management, Qualitative Research Methods, Public Health Systems & Services Research, Community health (Health Sciences), Qualitative Research Methodology, General Practice and Health, Health Services, Primary Healthcare, Health Science, Family Medicine, Medical Education, Primary prevention of lifestyle-associated chronic disease through community based collaborative action, Family and Community Medicine, and Primary and Secondary Prevention
The concept of systematic inequalities in social and health outcomes has come to form part of contemporary policy discourse. This rhetoric is deployed even in the face of policy decisions widely viewed as iniquitous. Moreover, there is a... more
The concept of systematic inequalities in social and health outcomes has come to form part of contemporary policy discourse. This rhetoric is deployed even in the face of policy decisions widely viewed as iniquitous. Moreover, there is a widespread view, expressed across the political spectrum, that those in more deprived circumstances are less likely than their more affluent counterparts to be in receipt of optimal public services. Such individuals and communities are variously described as excluded, disadvantaged, underserved or hard to reach. Across countries and policy domains the term 'hard to reach' is used to refer to those deemed not to be in optimal receipt of public sector services which are intended to increase some aspect of material, social or physical wellbeing. It is increasingly used in health policy documents which aim to address health inequalities. However, it is an ill-defined and contested term. The purpose of this paper is two-fold. First, it offers a critical commentary on the concept of hard-to-reachness and asks: who are viewed as hard to reach and why? Second, using a case-study of a Scottish health improvement programme that explicitly aims to reach and engage the 'hard to reach' in preventive approaches to cardiovascular disease, it tests the policy and practice implications of the concept. It finds that a lack of conceptual clarity leads to ambiguous policy and practice and argues for possible theoretical refinements.
Research Interests: Sociology, Social Theory, Health Sciences, Primary Care, General Practice, and 21 moreHealth Promotion, Social Sciences, Primary Health Care, Qualitative methodology, Family Medicine, Health Care Policy, Health Inequalities, Social Determinants of Health, Health Disparities, Qualitative Research, Public Health, Health Services Research, Health Policy, Social Determinants Of Health (Anthropology), Qualitative Research Methods, General Practice and Health, Patient Involvement, Health Science, Family Medicine, Medical Education, Family and Community Medicine, and Primary and Secondary Prevention
""BACKGROUND:Preventive approaches to health are disproportionately accessed by the more affluent and recent health improvement policy advocates the use of targeted preventive primary care to reduce risk factors in poorer individuals and... more
""BACKGROUND:Preventive approaches to health are disproportionately accessed by the more affluent and recent health improvement policy advocates the use of targeted preventive primary care to reduce risk factors in poorer individuals and communities. Outreach has become part of the health service response. Outreach has a long history of engaging those who do not otherwise access services. It has, however, been described as eclectic in its purpose, clientele and mode of practice; its effectiveness is unproven.Using a primary prevention programme in the UK as a case, this paper addresses two research questions: what are the perceived problems of non-engagement that outreach aims to address; and, what specific mechanisms of outreach are hypothesised to tackle these.
METHODS:Drawing on a wider programme evaluation, the study undertook qualitative interviews with strategically selected health-care professionals. The analysis was thematically guided by the concept of 'candidacy' which theorises the dynamic process through which services and individuals negotiate appropriate service use.
RESULTS:The study identified seven types of engagement 'problem' and corresponding solutions. These 'problems' lie on a continuum of complexity in terms of the challenges they present to primary care. Reasons for non-engagement are congruent with the concept of 'candidacy' but point to ways in which it can be expanded.
CONCLUSIONS:The paper draws conclusions about the role of outreach in contributing to the implementation of inequalities focused primary prevention and identifies further research needed in the theoretical development of both outreach as an approach and candidacy as a conceptual framework""
METHODS:Drawing on a wider programme evaluation, the study undertook qualitative interviews with strategically selected health-care professionals. The analysis was thematically guided by the concept of 'candidacy' which theorises the dynamic process through which services and individuals negotiate appropriate service use.
RESULTS:The study identified seven types of engagement 'problem' and corresponding solutions. These 'problems' lie on a continuum of complexity in terms of the challenges they present to primary care. Reasons for non-engagement are congruent with the concept of 'candidacy' but point to ways in which it can be expanded.
CONCLUSIONS:The paper draws conclusions about the role of outreach in contributing to the implementation of inequalities focused primary prevention and identifies further research needed in the theoretical development of both outreach as an approach and candidacy as a conceptual framework""
Research Interests: Social Theory, Health Sciences, Primary Care, Social Policy, Social Sciences, and 14 morePrimary Health Care, Family Medicine, Health Inequalities, Implementation Science, Social Determinants of Health, Health Disparities, Public Health, Health Services Research, Health Policy, Public Health Systems & Services Research, Health Systems, Health Science, Family and Community Medicine, and Primary and Secondary Prevention
BACKGROUND:The past decade has seen considerable interest in the development and evaluation of complex interventions to improve health. Such interventions can only have a significant impact on health and health care if they are shown to... more
BACKGROUND:The past decade has seen considerable interest in the development and evaluation of complex interventions to improve health. Such interventions can only have a significant impact on health and health care if they are shown to be effective when tested, are capable of being widely implemented and can be normalised into routine practice. To date, there is still a problematic gap between research and implementation. The Normalisation Process Theory (NPT) addresses the factors needed for successful implementation and integration of interventions into routine work (normalisation).DISCUSSION:In this paper, we suggest that the NPT can act as a sensitising tool, enabling researchers to think through issues of implementation while designing a complex intervention and its evaluation. The need to ensure trial procedures that are feasible and compatible with clinical practice is not limited to trials of complex interventions, and NPT may improve trial design by highlighting potential problems with recruitment or data collection, as well as ensuring the intervention has good implementation potential.SUMMARY:The NPT is a new theory which offers trialists a consistent framework that can be used to describe, assess and enhance implementation potential. We encourage trialists to consider using it in their next trial
Research Interests: Social Theory, Primary Care, Communication, Social Policy, Social Sciences, and 25 moreOrganizational Change, Primary Health Care, Normalisation Process Theory, Intercultural Management, Family Medicine, Health Care, Implementation Science, Health Services Research, Health Policy, Public Health Systems & Services Research, Change agents, Health Services, Middle Management, Case Study, Readiness for Change, Implementation, Multicultural, Managing Change, Involvement, Family and Community Medicine, Change Implementation, Change Resistance, Coping With Change, Change Factors, and Public Policy
Research Interests:
Research Interests:
BACKGROUND:Practice nurses have a key role within UK general practice, especially since the 2004 GMS contract. This study aimed to describe that role, identify how professionally supported they felt and their career intentions. An... more
BACKGROUND:Practice nurses have a key role within UK general practice, especially since the 2004 GMS contract. This study aimed to describe that role, identify how professionally supported they felt and their career intentions. An additional aim was to explore whether they felt isolated and identify contributory factors.METHODS:A cross-sectional questionnaire survey in one large urban Scottish Health Board, targeted all practice nurses (n = 329). Domains included demographics, workload, training and professional support. Following univariate descriptive statistics, associations between categorical variables were tested using the chi-square test or chi-square test for trend; associations between dichotomous variables were tested using Fisher's Exact test. Variables significantly associated with isolation were entered into a binary logistic regression model using backwards elimination.RESULTS:There were 200 responses (61.0% response rate). Most respondents were aged 40 or over and were practice nurses for a median of 10 years. Commonest clinical activities were coronary heart disease management, cervical cytology, diabetes and the management of chronic obstructive pulmonary disease. Although most had a Personal Development Plan and a recent appraisal, 103 (52.3%) felt isolated at least sometimes; 30 (15.5%) intended leaving practice nursing within 5 years.Isolated nurses worked in practices with smaller list sizes (p = 0.024) and nursing teams (p = 0.003); were less likely to have someone they could discuss a clinical/professional (p = 0.002) or personal (p < 0.001) problem with; used their training and qualifications less (p < 0.001); had less productive appraisals (p < 0.001); and were less likely to intend staying in practice nursing (p = 0.009). Logistic regression analysis showed that nurses working alone or in teams of two were 6-fold and 3.5-fold more likely to feel isolated. Using qualifications and training to the full, having productive appraisals and planning to remain in practice nursing all mitigated against feeling isolated.CONCLUSIONS:A significant proportion of practice nurses reported feeling isolated, at least some of the time. They were more likely to be in small practices and more likely to be considering leaving practice nursing. Factors contributing to their isolation were generally located within the practice environment. Providing support to these nurses within their practice setting may help alleviate the feelings of isolation, and could reduce the number considering leaving practice nursing