Faculty of Health and Social Development, School of Nursing, The University of British Columbia, Okanagan Campus, Kelowna, BC, V1V 1V7, Canada.
School of Health Studies, Arthur and Sonia Labatt Health Sciences Building, Western University, London, ON, N6A 5B9, Canada.
Health Res Policy Syst. 2024 Nov 4;22(1):148. doi: 10.1186/s12961-024-01191-x.
The implementation of the maternal perinatal death surveillance and response (MPDSR) policy is among the envisaged strategies to reduce the high global burden of maternal and perinatal mortality and morbidity. However, implementation of this policy across various contexts is inconsistent. Theoretically informed approaches to process evaluation can support assessment the implementation of policy interventions such as MPDSR, particularly in understanding what the actors involved actually do. In this article, we reflect on how the normalisation process theory (NPT) was used to explore implementation of the MPDSR policy in Uganda. NPT is a sociological theory concerned with the social organisation of the work (implementation) of making practices routine elements of everyday life (embedding) and of sustaining embedded practices in their social contexts (integration).
This qualitative multiple case study conducted across eight districts in Uganda and among 10 health facilities (cases) representing four out of the seven levels of the Uganda health care system. NPT was utilised in several ways including informing the study design, structuring the data collection tools (semi-structured interview guides), providing an organising framework for analysis, interpreting and reporting of study findings as well as making recommendations. Study participants were purposely selected to reflect the range of actors involved in the policy implementation process. This included direct care providers located at each of the cases, the Ministry of Health and from agencies and professional associations. Data were collected using semi-structured, in-depth interviews and were inductively and deductively analysed using NPT constructs and subconstructs.
NPT served useful for process evaluation, particularly in identifying factors that contribute to variations in policy implementation. Considering the NPT focus on the agency of people involved in implementation, additional efforts are required to understand how recipients of the policy intervention influence how the intervention becomes embedded within the various contexts.
孕产妇围产死亡监测与应对（MPDSR）政策的实施是降低全球孕产妇和围产儿高死亡率和发病率负担的预期策略之一。然而，在不同的背景下，该政策的实施情况并不一致。理论上有依据的过程评估方法可以支持评估 MPDSR 等政策干预措施的实施情况，特别是在理解相关人员实际所做的工作方面。本文中，我们反思了如何利用规范化进程理论（NPT）来探索乌干达 MPDSR 政策的实施情况。NPT 是一种社会学理论，关注于实践常规化和日常化（嵌入）以及在社会背景下维持嵌入实践的工作（实施）的社会组织（整合）。
本研究是在乌干达 8 个区和 10 个卫生机构（案例）中进行的多案例定性研究，这些机构代表了乌干达医疗保健系统的 7 个层次中的 4 个。NPT 以多种方式被利用，包括为研究设计提供信息、构建数据收集工具（半结构化访谈指南）、为分析提供组织框架、对研究结果进行解释和报告以及提出建议。研究参与者是经过精心挑选的，以反映参与政策实施过程的各种人员。这些人员包括位于每个案例中的直接护理提供者、卫生部以及来自机构和专业协会的人员。使用半结构化深入访谈收集数据，并使用 NPT 结构和子结构进行归纳和演绎分析。
NPT 对过程评估很有用，特别是在确定导致政策实施差异的因素方面。考虑到 NPT 对参与实施的人员的能动性的关注，需要进一步努力了解政策干预的接受者如何影响干预措施在各种背景下的嵌入。
