Morden Andrew, Brooks Lauren, Jinks Clare, Porcheret Mark, Ong Bie Nio, Dziedzic Krysia
Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
J Health Organ Manag. 2015;29(7):798-821. doi: 10.1108/JHOM-07-2014-0119.
Intervention evaluations have not always accounted for long-term implementation of interventions. The purpose of this paper is to explore implementation of a primary care intervention during the lifespan of the trial and beyond.
DESIGN/METHODOLOGY/APPROACH: Eight general practices participated in the trial (four control and four intervention). In-depth interviews (with nine GPs and four practices nurses who delivered the intervention) and observation methods were employed. Thematic analysis was utilized and Normalization Process Theory (NPT) constructs were compared with emergent themes.
Macro-level policy imperatives shaped practice priorities which resulted in the "whole system" new intervention not being perceived to be sustainable. Continued routinization of the intervention into usual care beyond the lifespan of the funded study was dependent on individualized monitoring and taking forward tacit knowledge.
RESEARCH LIMITATIONS/IMPLICATIONS: The authors discuss the implications of these findings for sociological theories of implementation and understanding outcomes of research led complex interventions.
ORIGINALITY/VALUE: The study describes the complex interplay between macro processes and individual situated practices and contributes to understanding if, how, and why interventions are sustained beyond initial "research push". The value of the study lies in describing the conditions and potential consequences of long-term implementation, which might be translated to other contexts.
干预评估并非总能考虑到干预措施的长期实施情况。本文旨在探讨在试验期间及之后的整个阶段，一项初级保健干预措施的实施情况。
设计/方法/途径：八家普通诊所参与了该试验（四家对照诊所和四家干预诊所）。采用了深度访谈（与实施干预措施的九名全科医生和四名执业护士进行访谈）及观察方法。运用了主题分析法，并将规范化过程理论（NPT）的构建与新出现的主题进行了比较。
宏观层面的政策要求塑造了实践重点，这导致“整个系统”的新干预措施被认为无法持续。在资助研究期之后，将干预措施持续常规化纳入常规护理，取决于个性化监测和传承隐性知识。
研究局限性/启示：作者讨论了这些研究结果对实施社会学理论以及理解由研究主导的复杂干预措施结果的启示。
原创性/价值：该研究描述了宏观过程与个体具体实践之间的复杂相互作用，并有助于理解干预措施是否、如何以及为何能在最初的“研究推动”之后持续下去。该研究的价值在于描述长期实施的条件和潜在后果，这些可能适用于其他情况。
