Especially in a system where public health resources

This preview shows page 67 - 69 out of 211 pages.

especially in a system where public health resources are limited and other conditions effecting thousands, or even millions more people are vying for those resources. Aside from money, it would be hard to convince a GP to address avoiding this unusual injury during a consultation when he or she could be addressing smoking or alcohol consumption. In both these contexts the intervention becomes invalid. These contextual issues are highlighted at each of the stages of the NPT, but most thoroughly at contextual integration in collective action where the theory asks how the intervention will fit with those practices already in place, and where there new intervention does not fit with existing practices, how this can be overcome. The context into which a healthcare intervention must fit is invariably complex, with other practices competing for resources such as time and money. Murray et
68 al give the example of the ImPACT back pain trial (Tooth et al, 2009) where the researchers discovered that in the context of a consultation back pain was rarely the primary complaint of the patient. As a result GPs did not place importance on discussing back pain and making referrals, this low coherence lead to low cognitive engagement and low participation. Having defined the context, the next stage is to define the intervention. Relevant NPT concepts once again occur at each of the first three stages including differentiation, enrolment and skillset workability (the reflexive monitoring stage was purposefully omitted from this list as evaluation will be discussed in detail later in this chapter). The NPT sensitises the researcher to issues around how the intervention must be perceived as different from practices, while fitting with the current context and how the necessary people must be organised and trained in line with current roles and strengths. Once both context and intervention are defined, an NPT evaluation of the intervention can take place. In the “trial killer” paper Murray and colleagues (2010) put forward a series of questions developed from the NPT to offer a framework to decide whether the new intervention is likely to be effectively normalised in the given context. These questions cover each of the concepts of the NPT. For example, a question to address differentiation from the concept of coherence is “Is the intervention clearly distinct from other interventions?” A question addressing contextual integration from the concept of collective action is “How compatible is it with existing practices?” To address these questions, a combination of the previous literature and primary data is likely to be required, in doing this the NPT can sensitise researchers to the requirements of new interventions if they are to become normalised in complex contexts such as primary care where the new intervention must both fit with current practices while being a distinct practice, and where people must be effectively engaged and remain engaged in order for the new intervention to compete effectively for

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture