Bumpy road: implementing integrated psychiatric and somatic care in joint-specialty emergency departments: a mixed-method study using Normalization Process Theory

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Pia Vedel Ankersen ◽  
Rikke Grynderup Steffensen ◽  
Emely Ek Blæhr ◽  
Kirsten Beedholm
Keyword(s):  
Mental Illness ◽  
Emergency Departments ◽  
Single Case ◽  
Qualitative Interviews ◽  
Normalization Process Theory ◽  
Process Theory ◽  
Content Type ◽  
People With Mental Illness ◽  
Somatic Illness ◽  
Normalization Process

PurposeLife expectancy is 15–20 years shorter for individuals with than for people without mental illness. Assuming that undiagnosed and undertreated somatic conditions are significant causes, the Central Denmark Region set out to implement joint psychiatric and somatic emergency departments (EDs) to support integrated psychiatric/somatic care as an effort to prolong the lifetime of individuals with mental illness. Through the lens of Normalization Process Theory, the authors examine healthcare frontline staff’s perceptions of and work with the implementation of integrated psychiatric/somatic care in the first joint-specialty ED in Denmark.Design/methodology/approachA single-case mixed-methods study using Normalization Process Theory (NPT) as an analytic framework to evaluate implementation of psychiatric/somatic integrated care (IC) in a joint-specialty emergency department. Data were generated from observations, qualitative interviews and questionnaires distributed to the frontline staff.FindingsImplementation was characterized by a diffuse normalization leading to an adaption of the IC in a fuzzy alignment with existing practice. Especially, confusion among the staff regarding how somatic examination in the ED would ensure prolonged lifetime for people with mental illness was a barrier to sense-making and development of coherence among the staff. The staff questioned the accuracy of IC in the ED even though they recognized the need for better somatic care for individuals with mental illness.Practical implicationsThis study highlights that a focus on outcomes (prolonging lifetime for people with mental illness and reducing stigmatization) can be counterproductive. Replacing the outcome focus with an output focus, in terms of how to develop and implement psychiatric/somatic IC with the patient perspective at the center, would probably be more productive.Originality/valueIn 2020, the Danish Health Authorities published new whole-system recommendations for emergency medicine (EM) highlighting the need for intensifying integrated intra and interorganizational care including psychiatric/somatic IC (ref). Even though this study is not conclusive, it points to subjects that can help to identify resources needed to implement psychiatric/somatic IC and to pitfalls. The authors argue that the outcome focus, prolonging the lifetime for individuals with mental illness by identifying somatic illness, was counterproductive. In accordance with the recommendations of contemporary implementation studies, the authors recommend a shift in focus from outcome to output focus; how to develop and implement psychiatric/somatic IC.

scholarly journals Combining Realist approaches and Normalization Process Theory to understand implementation: a systematic review

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Sonia Michelle Dalkin ◽  
Rebecca J. L. Hardwick ◽  
Catherine A. Haighton ◽  
Tracy L. Finch
Keyword(s):  
Systematic Review ◽  
Health Management ◽  
Explanatory Power ◽  
Family Health ◽  
Realist Evaluation ◽  
Normalization Process Theory ◽  
Process Theory ◽  
Scientific Realist ◽  
Health Database ◽  
Normalization Process

Abstract Background Realist approaches and Normalization Process Theory (NPT) have both gained significant traction in implementation research over the past 10 years. The aim of this study was therefore to explore how the approaches are combined to understand problems of implementation, to determine the degree of complementarity of the two approaches and to provide practical approaches for using them together. Methods Systematic review of research studies combining Realist and NPT approaches. Realist methodology is concerned with understanding and explaining causation, that is, how and why policies, programmes and interventions achieve their effects. NPT is a theory of implementation that explains how practices become normalised. Databases searched (January 2020) were ASSIA, CINAHL, Health Research Premium Collection via Proquest (Family Health Database, Health & Medical Collection, Health Management Database, MEDLINE, Nursing & Allied Health Database, Psychology Database, Public Health Database) and PsycARTICLES. Studies were included if the author(s) stated they used both approaches: a scientific Realist perspective applying the principles of Pawson and Tilley’s Realist Evaluation or Pawson’s Realist Synthesis and Normalization Process Theory either solely or in addition to other theories. Two authors screened records; discrepancies were reviewed by a third screener. Data was extracted by three members of the team and a narrative synthesis was undertaken. Results Of 245 total records identified, 223 unique records were screened and 39 full-text papers were reviewed, identifying twelve papers for inclusion in the review. These papers represented eight different studies. Extent and methods of integration of the approaches varied. In most studies (6/8), Realist approaches were the main driver. NPT was mostly used to enhance the explanatory power of Realist analyses, informing development of elements of Contexts, Mechanisms and Outcomes (a common heuristic in realist work). Authors’ reflections on the integration of NPT and Realist approaches were limited. Conclusions Using Realist and NPT approaches in combination can add explanatory power for understanding the implementation of interventions and programmes. Attention to detailed reporting on methods and analytical process when combining approaches, and appraisal of theoretical and practical utility is advised for advancing knowledge of applying these approaches in research. Systematic review registration Not registered.

Human rights of people with mental illness diagnosis: perceptions among service users, family members and health professionals in Tunisia

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mayssa Rekhis ◽  
Sami Ouanes ◽  
Abir Ben Hamouda ◽  
Rym Rafrafi
Keyword(s):  
Mental Illness ◽  
Human Rights ◽  
Family Members ◽  
Mental Illnesses ◽  
Service Users ◽  
Content Type ◽  
People With Mental Illness ◽  
The Family ◽  
The Right ◽  
Main Factor

Purpose This study aims to assess the awareness about the rights of people with mental illness in the main psychiatric hospital in Tunisia among the service users, the family members and the staff. Design/methodology/approach The Convention of Rights of People with Disabilities mandates that State Parties initiate and maintain campaigns and human rights training to promote understanding of the rights of people with mental illnesses, considered as a main factor for their fulfillment. Service users, family members and staff evaluated, through a survey, the importance of ten rights for persons with mental illness, stated in the convention. Findings Disparities were found in the perception of the different rights by and between the three groups. The highest levels of awareness were associated with the freedom from torture or degrading treatment and the right to live with dignity and respect, whereas the lower importance were assigned to the right to participation in recovery plans, to give consent and to exercise legal capacity. Originality/value The lack of awareness and the poor perception of rights of people with mental illness is one of the barriers to their achievement. More training and awareness raising is necessary.

scholarly journals The Swedish version of the Normalization Process Theory Measure S-NoMAD: translation, adaptation, and pilot testing

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Marie Elf ◽  
Sofi Nordmark ◽  
Johan Lyhagen ◽  
Inger Lindberg ◽  
Tracy Finch ◽  
...  
Keyword(s):  
Normalization Process Theory ◽  
Process Theory ◽  
Swedish Version ◽  
Pilot Testing ◽  
Normalization Process

scholarly journals Impact of a health literacy intervention combining general practitioner training and a consumer facing intervention to improve colorectal cancer screening in underserved areas: protocol for a multicentric cluster randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie-Anne Durand ◽  
Aurore Lamouroux ◽  
Niamh M. Redmond ◽  
Michel Rotily ◽  
Aurélie Bourmaud ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Literacy ◽  
Normalization Process Theory ◽  
Trial Registration ◽  
Process Theory ◽  
Crc Screening ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
The Impact ◽  
Normalization Process

Abstract Background Colorectal cancer (CRC) is a leading cause of cancer burden worldwide. In France, it is the second most common cause of cancer death after lung cancer. Systematic uptake of CRC screening can improve survival rates. However, people with limited health literacy (HL) and lower socioeconomic position rarely participate. Our aim is to assess the impact of an intervention combining HL and CRC screening training for general practitioners (GPs) with a pictorial brochure and video targeting eligible patients, to increase CRC screening and other secondary outcomes, after 1 year, in several underserved geographic areas in France. Methods We will use a two-arm multicentric randomized controlled cluster trial with 32 GPs primarily serving underserved populations across four regions in France with 1024 patients recruited. GPs practicing in underserved areas (identified using the European Deprivation Index) will be block-randomized to: 1) a combined intervention (HL and CRC training + brochure and video for eligible patients), or 2) usual care. Patients will be included if they are between 50 and 74 years old, eligible for CRC screening, and present to recruited GPs. The primary outcome is CRC screening uptake after 1 year. Secondary outcomes include increasing knowledge and patient activation. After trial recruitment, we will conduct semi-structured interviews with up to 24 GPs (up to 8 in each region) and up to 48 patients (6 to 12 per region) based on data saturation. We will explore strategies that promote the intervention’s sustained use and rapid implementation using Normalization Process Theory. We will follow a community-based participatory research approach throughout the trial. For the analyses, we will adopt a regression framework for all quantitative data. We will also use exploratory mediation analyses. We will analyze all qualitative data using a framework analysis guided by Normalization Process Theory. Discussion Limited HL and its impact on the general population is a growing public health and policy challenge worldwide. It has received limited attention in France. A combined HL intervention could reduce disparities in CRC screening, increase screening rates among the most vulnerable populations, and increase knowledge and activation (beneficial in the context of repeated screening). Trial registration Registry: ClinicalTrials.gov. Trial registration number: 2020-A01687-32. Date of registration: 17th November 2020.

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