Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review - 2020

Sly Saint

Senior Member (Voting Rights)
Abstract
Background

Normalisation Process Theory (NPT) provides a framework to understand how interventions are implemented, embedded, and integrated in healthcare settings. Previous reviews of published literature have examined the application of NPT across international healthcare and reports its benefits. However, given the distinctive clinical function, organisational arrangements and the increasing management of people with a wide variety of conditions in primary care settings in the United Kingdom, it is important to understand how and why authors utilise and reflect on NPT in such settings to inform and evaluate implementation processes.

Methods
A systematic review of peer-reviewed literature using NPT in primary care settings in the United Kingdom (UK) was conducted. Eight electronic databases were searched using replicable methods to identify articles published between January 2012 and April 2018. Data were analysed using a framework approach.

Results
Thirty-one articles met the inclusion criteria. Researchers utilised NPT to explore the implementation of interventions, targeting a wide range of health services and conditions, within primary care settings in the UK. NPT was mostly applied qualitatively; however, a small number of researchers have moved towards mixed and quantitative methods. Some variation was observed in the use of NPT constructs and sub-constructs, and whether and how researchers undertook modification to make them more relevant to the implementation process and multiple stakeholder perspectives.

Conclusion
NPT provides a flexible framework for the development and evaluation of complex healthcare interventions in UK primary care settings. This review updates the literature on NPT use and indicates that its application is well suited to these environments, particularly in supporting patients with long-term conditions and co-morbidities. We recommend future research explores the receipt of interventions by multiple stakeholders and suggest that authors reflect on justifications for using NPT in their reporting.
Primary care topics under investigation
Thirteen articles reported the use of NPT to investigate interventions targeting long-term conditions [31,32,33, 36, 37, 42,43,44,45, 48, 51, 53, 57]. Conditions included hypertension, chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME), heart failure, kidney disease, chronic obstructive pulmonary disease, asthma, long-term conditions in general, and mental health conditions.

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a fancy way to write about protocols new language doesn't change the fact that most if not all healthcare industry protocols are not actually based on addressing patients needs and have everything to do with costs . another paper written just so the authors can claim to have published .
 
Wow. It took me a couple of goes to get my head around the title.

Words for the sake of words.

I can't be bothered.

A systematic review of peer-reviewed literature using NPT in primary care settings in the United Kingdom (UK) was conducted.

I'll wait till a few more reviews have been done and then read the meta analysis on that thanks.
 
This is so waffly/full of sociology blurb but the following sentence under the sub-heading "use and adaptation of NPT" (a couple of paras up from Table 5) made me want to shout out an expletive or 3.

"However, one paper suggests that focussing on the individual and collective agency of actors who are delivering the intervention risk neglecting the agency of those who receive the intervention – particularly at a patient or service user level [44]."

Also, under the heading:

"NPT as a facilitator of understanding" - ( just under Table 5 in Results section.)

"For example, Bayliss et al. reported that NPT revealed that owing to a large number of barriers the CFS/ME intervention was not feasible, and concluded that “time pressures and competing priorities meant that some GPs failed to engage with the training module (cognitive participation). When the module was completed, many GPs stated that it was not feasible to retain even the key messages as they saw so few patients with the condition” [32]."

32.

Bayliss K, Riste L, Band R, Peters S, Wearden A, Lovell K, et al. Implementing resources to support the diagnosis and management of chronic fatigue syndrome/Myalgic encephalomyelitis (CFS/ME) in primary care: a qualitative study. BMC Fam Pract. 2016;17(1):66.

(The above paper is not a recommendation - numerous comments by GPs ....)

 
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