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Implementation Science

, 11:141

First Online: 19 October 2016Received: 05 June 2016Accepted: 07 October 2016DOI: 10.1186-s13012-016-0506-3

Cite this article as: May, C.R., Johnson, M. & Finch, T. Implementation Sci 2016 11: 141. doi:10.1186-s13012-016-0506-3

Abstract

BackgroundContext is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice.

DiscussionWe present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems.

ConclusionImplementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of ‘real world’ contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants’ discretion over resource mobilisation and actors’ contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems.

AbbreviationsCAREDEMCollaborative cARE for people with DEMentia in primary care Trial Acronym

CASComplex adaptive system

FVFamily violence

MOVEImproving maternal and child health nurse care for vulnerable mothers Trial Acronym

NPTNormalisation Process Theory

TRACSRandomized Controlled Trial of Caregiver Training after Stroke Trial Acronym

WISEWhole System Informing Self-management Engagement Trial Acronym

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Autor: Carl R. May - Mark Johnson - Tracy Finch

Fuente: https://link.springer.com/







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