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    REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings (RESTORE): study protocol

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    Authors
    MacFarlane, Anne
    O’Donnell, Catherine
    Mair, Frances
    O’Reilly-de Brún, Mary
    de Brún, Tomas
    Spiegel, Wolfgang
    van den Muijsenbergh, Maria
    van Weel-Baumgarten, Evelyn
    Lionis, Christos
    Burns, Nicola
    Gravenhorst, Katja
    Princz, Christine
    Teunissen, Erik
    van den Driessen Mareeuw, Francine
    Saridaki, Aristoula
    Papadakaki, Maria
    Vlahadi, Maria
    Dowrick, Christopher
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    Issue Date
    2012-11-20
    
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    Citation
    Implementation Science. 2012 Nov 20;7(1):111
    URI
    http://dx.doi.org/10.1186/1748-5908-7-111
    http://hdl.handle.net/10147/264777
    Abstract
    Abstract Background The implementation of guidelines and training initiatives to support communication in cross-cultural primary care consultations is ad hoc across a range of international settings with negative consequences particularly for migrants. This situation reflects a well-documented 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.
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