What work has to be done to implement collaborative care for depression Process evaluation of a trial utilizing the Normalization Process ModelReport as inadecuate




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Implementation Science

, 5:15

First Online: 10 February 2010Received: 21 June 2009Accepted: 10 February 2010DOI: 10.1186-1748-5908-5-15

Cite this article as: Gask, L., Bower, P., Lovell, K. et al. Implementation Sci 2010 5: 15. doi:10.1186-1748-5908-5-15

Abstract

BackgroundThere is a considerable evidence base for -collaborative care- as a method to improve quality of care for depression, but an acknowledged gap between efficacy and implementation. This study utilises the Normalisation Process Model NPM to inform the process of implementation of collaborative care in both a future full-scale trial, and the wider health economy.

MethodsApplication of the NPM to qualitative data collected in both focus groups and one-to-one interviews before and after an exploratory randomised controlled trial of a collaborative model of care for depression.

ResultsFindings are presented as they relate to the four factors of the NPM interactional workability, relational integration, skill-set workability, and contextual integration and a number of necessary tasks are identified. Using the model, it was possible to observe that predictions about necessary work to implement collaborative care that could be made from analysis of the pre-trial data relating to the four different factors of the NPM were indeed borne out in the post-trial data. However, additional insights were gained from the post-trial interview participants who, unlike those interviewed before the trial, had direct experience of a novel intervention. The professional freedom enjoyed by more senior mental health workers may work both for and against normalisation of collaborative care as those who wish to adopt new ways of working have the freedom to change their practice but are not obliged to do so.

ConclusionsThe NPM provides a useful structure for both guiding and analysing the process by which an intervention is optimized for testing in a larger scale trial or for subsequent full-scale implementation.

Electronic supplementary materialThe online version of this article doi:10.1186-1748-5908-5-15 contains supplementary material, which is available to authorized users.

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