Archives

  • 2018-07
  • 2018-10
  • 2018-11
  • 2019-04
  • 2019-05
  • 2019-06
  • 2019-07
  • 2019-08
  • 2019-09
  • 2019-10
  • 2019-11
  • 2019-12
  • 2020-01
  • 2020-02
  • 2020-03
  • 2020-04
  • 2020-05
  • 2020-06
  • 2020-07
  • 2020-08
  • 2020-09
  • 2020-10
  • 2020-11
  • 2020-12
  • 2021-01
  • 2021-02
  • 2021-03
  • 2021-04
  • 2021-05
  • 2021-06
  • 2021-07
  • 2021-08
  • 2021-09
  • 2021-10
  • 2021-11
  • 2021-12
  • 2022-01
  • 2022-02
  • 2022-03
  • 2022-04
  • 2022-05
  • 2022-06
  • 2022-07
  • 2022-08
  • 2022-09
  • 2022-10
  • 2022-11
  • 2022-12
  • 2023-01
  • 2023-02
  • 2023-03
  • 2023-04
  • 2023-05
  • 2023-06
  • 2023-07
  • 2023-08
  • 2023-09
  • 2023-10
  • 2023-11
  • 2023-12
  • 2024-01
  • 2024-02
  • 2024-03
  • 2024-04
  • 2024-05

    • Increasing attention is therefore being paid to intervention

    2018-11-05

    Increasing attention is therefore being paid to intervention-context interactions, and their influence on implementation processes and hypothesized outcomes (Moore et al., 2014). It is important to understand how practitioners engage with interventions because this can provide insights into why fidelity and intervention effectiveness vary over space and time, and the extent to which an intervention may be adopted. One important contribution to the study of these processes is Extended Normalisation Process Theory (ENPT) (May, 2013) which seeks “to provide a more comprehensive explanation of the constituents of implementation processes” by integrating existing theories that are more concerned with specific processes, such as intervention delivery, faah inhibitor and normalisation. ENPT conceptualises implementation as comprising practitioners - who have agency that is manifested when they interact with each other and with intervention components; and implementation contexts comprising “the socio-structural and social-cognitive resources that people draw on to realise that agency”. It therefore offers a useful framework for explaining implementation processes and the role played by intervention-context interactions. ENPT has four main constructs. First, potential concerns practitioners’ commitment to deliver an intervention and behave in ways which are congruent with its aims, underpinning the action necessary to embed it within agents’ working practice (May, 2013). Whether practitioners value the changes an intervention brings about (change valence) and perceive that the changes are feasible within their local context (change efficacy), determine levels of commitment (Weiner, 2009). Second, capability concerns the possibilities presented by the intervention. Capability comprises: workability - how practitioners adjust what they do when organising an intervention - for example, (re)allocation of roles and responsibilities; and integration - how practitioners perceive implementation of an intervention to be linked to the wider social system. Third, capacity is the structure into which an intervention is introduced. Implementation depends on agents’ co-operation to accommodate the intervention by modifying norms and roles in social systems and redistributing resources, e.g. providing funding (May, 2013). Potential, capability and capacity form the context for the fourth construct - contribution. This comprises the ways in which practitioners make sense of a complex intervention and their role in delivering it, the enactment of the intervention itself, and reflexive monitoring of its effects. The enactment of the intervention is expected to have specific qualities for each process evaluation component (e.g. adherence to programme manuals). Differences and similarities between expectations and practice can thus be explained in terms of potential, capability and capacity. A small number of empirical studies have employed ENPT as a theoretical framework to understand the implementation of interventions within healthcare systems (Drew, et al., 2015; Thomas, Bendsten & Krevers, 2015). Our paper – which applies ENPT to a social intervention outside the healthcare system, reports findings from a process evaluation within a randomised controlled trial of the Strengthening Families Programme (SFP) 10-14 UK. We build on previous studies which have employed ENPT mainly to analyse implementation processes, by extending its application to explain how such processes shape the extent to which programme inputs and activities occur as intended: fidelity (adherence to SFP 10–14 content and implementation requirements); dose delivered (number of programmes organised); dose received (participant interest/engagement); reach (the proportion of families in the intervention group that participated in SFP 10–14); and participant recruitment (Linnan & Steckler, 2002). In doing so, this paper aids interpretation of outcome effects within the trial, develops our understanding of how SFP 10–14 could be implemented in a UK setting, and assesses the potential for ENPT to contribute to understanding of implementing social interventions within complex systems. The paper also extends previous process evaluations of SFP 10-14 which have focused mainly on the quantitative assessment of implementation (e.g. Byrne, Miller, Aalborg, Plasencia & Keagy, 2010; Spoth et al., 2007; Spoth, Guyll, Trudeau & Goldberg-Lillehoj, 2002).