Using NPT in RESTOREProfessor Kate O’DonnellFor the RESTORE team NPT training November 2012.

Aim of this presentation

• To explain what we mean by “theory”.• To explain why we use theory in research.• To talk about NPT - the theory we are using in RESTORE• To explain why NPT helps us in our work in RESTORE.

What is theory?

It’s a systematic and general attempt to explain something that we are interested in.

Sets out a credible way of looking at the world, which we can then test in our work.

Why is theory important?

Offers a generalisable framework that can be applied across settings and individuals.

Offers the opportunity for the incremental accumulation of knowledge.

Offers an explicit framework for analysis.

Eccles et al. Implementation Science 2009; 4: 18.

RESTORE Aim.

To optimise the delivery of primary healthcare to European citizens who are migrants and experiencing language and cultural barriers in their host countries.

How?

By carrying out research into the implementation of evidence-based health information designed to address language and cultural barriers in primary care settings in Europe.

What is Normalisation Process Theory?

• Developed by Carl May and colleagues.• A mid-level sociological theory – developed by integrating theory

(which helps us “explain” the world) and empirical research.• Derived from empirical work on the implementation of ehealth

initiatives.• Further tested on a range of complex interventions, involving

practitioners, implementors and patients.• Now applied to a wide range of services and conditions.

• NPT focuses on the work that individuals and groups have to do for a new technology/practice/way of working to become embedded and sustained in routine practice.

• It is about both implementation and routinisation.

“Helps us to identify and understand factors which promote and inhibit the routine incorporation of complex interventions in everyday practice.”

Murray et al. BMC Medicine 2010.

In RESTORE, the complex intervention will be the guidance or training initiative that has been identified and selected by stakeholders during the SASI events.

In CAPES, you will start to consider what work and actions stakeholders need to do to implement the G/TI.

You may also consider the need to ‘fine-tune’ the G/TI and NPT can inform this process

NPT will help inform the development of CAPES and, more importantly, inform the analysis of the data generated during CAPES.

WIDE

• Initial meetings to establish stakeholder group(s).

• NPT was introduced to all

SASI

• Used NPT to help screen identified G/TIs

• Offered basket of 3-6 G/TIs to stakeholders

CAPES

• NPT will help to inform the areas you need to explore with stakeholders.

• NPT will inform analysis of data generated during CAPES

Mapping Exercise took place

In order to do this, we need to consider the four constructs on NPT again…….

NPT Constructs.

Construct What it addressesCoherence Can stakeholders make sense of it?

Cognitive Participation Can stakeholders get others involved and engaged in it?

Collective Action What has to be done to make it work in routine practice?

Reflexive Monitoring How can it be monitored and evaluated?

Coherence Cognitive Participation

Collective ActionReflexive

Monitoring

Thinking about doing

Doing the doing

WIDE

• Initial meetings to establish stakeholder group(s).

• May have introduced NPT as an idea.

SASI

• Used NPT to help screen identified G/TIs.

• Offered basket of 3-6 G/TIs to stakeholders

CAPES

• NPT will help to inform the areas you need to explore with stakeholders.

• NPT will inform analysis of data generated during CAPES

Mapping Exercise took place

Can stakeholders make senseof the G/TI presented?

Things to consider in CAPES:

Is this a new way of working?Is it very different from how things are currently done? If yes, how?Does everyone have the same view about what the G/TI is trying to achieve? And about what the benefits might be?Can the stakeholders talk about what might have to be done to implement this in practice?Can they see potential benefits of this G/Ti for them?

Coherence

Can stakeholders engage with the implementing the G/Ti?Can they get others involved?

Things to consider in CAPES:

Do the stakeholders think they are the right people to be driving the implementation of the G/Ti?Are the stakeholders willing, and able, to get others involved in implementing the G/Ti?Can the stakeholders work together to implement the G/Ti?Can the stakeholders identify what actions and activities will be needed to sustain the new work described in the G/Ti?

Cognitive Participation

In practice, what activities will promote or hinder the implementation of the G/Ti?

Things to consider in CAPES:

Will stakeholders (or others involved in implementation) be able to perform the tasks suggested by the G/Ti?Will it be better than their usual way of working?Will those involved in implementation maintain their trust in each other’s work and expertise?Will those allocated the work have the right range of skills and training to do the job?Will implementation be supported by management and other groups?Will implementation be supported by training, money, national or local policy? Collective

Action

How will stakeholders judge and monitor the implementation of the G/TI and its effects on practice?

Things to consider in CAPES:

Will stakeholders be able to judge the effectiveness and usefulness of the G/Ti in their local setting?How will they do this?What will they do with the information generated?Will they try to adapt or modify what they are doing?

Reflexive Monitoring

Coherence Cognitive Participation

Collective Action Reflexive Monitoring

Differentiation Initiation Interactional workability

Systematisation

Communal specification

Legitimation Relational integration

Communal appraisal

Individual specification

Enrolment Skill set workability Individual appraisal

Internalisation Activation Contextual integration

Reconfiguration

Acknowledgements.

RESTORE was funded by the European Union’s FP7 Health Programme, contract number 257258.

The work was led by Professor Anne MacFarlane, University of Limerick, Eire.

This presentation was delivered to the RESTORE team in November 2012.

http://www.fp7restore.eu/

NPT Training for the RESTORE project.

This presentation was designed and delivered by:

Professors Kate O’Donnell and Frances Mair, University of Glasgow, Scotland.

Professor Christopher Dowrick, University of Liverpool, England.

Professor Anne MacFarlane, University of Limerick, Eire.

For further information, contact: Kate.O’Donnell@glasgow.ac.uk