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Participatory approaches to implementation science (IS) offer an inclusive, collaborative, and iterative perspective on implementing and sustaining evidence-based interventions (EBIs) to advance health equity. This review provides guidance on the principles and practice of participatory IS, which enables academic researchers, community members, implementers, and other actors to collaboratively integrate practice-, community-, and research-based evidence into public health and health care services. With a foundational focus on supporting academics in coproducing knowledge and action, participatory IS seeks to improve health, reduce inequity, and create transformational change. The three main sections of this review provide (a) a rationale for participatory approaches to research in implementation science, (b) a framework for integrating participatory approaches in research utilizing IS theory and methods, and (c) critical considerations for optimizing the practice and impact of participatory IS. Ultimately, participatory approaches can move IS activities beyond efforts to make EBIs work within harmful systems toward transformative solutions that reshape these systems to center equity. [ABSTRACT FROM AUTHOR]

Recent developments of the concept of "sense of community" have highlighted the multiplicity of people's senses of community. In this article, the authors introduce the theory of the dialogical self as a means of theorizing the conflicts that can arise between a person's commitments to multiple communities. They ask the question, "When faced with conflicting community commitments, how does a person decide where his or her allegiances lie?" The contribution of the theory of the dialogical self is illustrated through an idiographic analysis of diaries kept by one British woman living through World War II. Conflicting commitments to her home community and to the national community's war effort provoke troubling dilemmas and efforts to resolve them through internal dialogues. Contributions to theory, research, and practice are discussed. (Contains 1 figure and 2 footnotes.)

This article looks at the experiences of young people with Statements of special educational needs prior to and following moves from primary to secondary school. Pam Maras and Emma-Louise Aveling of the University of Greenwich, London, used interviews to develop six qualitative case studies focusing on the transition process. Findings from these case studies reveal that the young people varied in their expectations and needs during the transition to secondary school, and that schools differed in the quality and efficacy of the support systems they provide. Parents' and carers' responses suggest that additional support services were not necessarily the most beneficial way to provide for all of the young people. What did appear to be beneficial was continuity of support throughout the transition to a new school, and the provision of a dedicated space within the school, such as a special needs unit. Several of the young people adapted easily alongside their peers without special educational needs, while others required more structured support. Pam Maras and Emma-Louise Aveling suggest that effective communication between support services, the young person, and their parents can facilitate successful transitions by allowing support to be tailored to individual students' needs.

Large-scale (e.g., national) programs could strengthen safety culture, which is foundational to patient safety, yet we know little about how to optimize this potential. In 2013, Brazil's Ministry of Health launched the National Patient Safety Program, involving hospital-level safety teams and targeted safety protocols. We conducted in-depth qualitative case studies of National Patient Safety Program implementation in two hospitals, with different readiness, to understand how program implementation affected enabling, enacting, and elaborating processes that produce and sustain safety culture. For both hospitals, external mandates were insufficient for enabling hospital-level action. Internal enabling failures (e.g., little safety-relevant senior leadership) hindered enactment (e.g., safety teams unable to institute plans). Limited enactment and weak elaboration processes (e.g., bureaucratic monitoring) failed to institutionalize protocol use and undermined safety culture. Optimizing the safety culture impact of large-scale programs requires effective multi-level enabling and capitalizing on the productive potential of interacting national- and local-level influences. [ABSTRACT FROM AUTHOR]

Team-based care is considered central to achieving value in primary care, yet results of large-scale primary care transformation initiatives have been mixed. We explore how underlying change processes influence the effectiveness of transition to team-based care. We studied 12 academically affiliated primary care practices participating in a learning collaborative, using longitudinal staff survey data to measure progress toward team-based care and qualitative interviews with practice staff to understand practice transformation. Transformation efforts focused on team formation and capacity building for quality improvement. Using thematic analysis, we explored types of change processes undertaken and the relationship between change processes and effective team-based care. We identified three prototypical approaches to change: pursuing functional and cultural change processes, functional only, and cultural only. Practice sites prioritizing both change processes formed the most effective teams: simultaneous functional and cultural change spurred a mutually reinforcing virtuous cycle. We describe implications for research, practice, and policy. [ABSTRACT FROM AUTHOR]

Background: The need to expand and better engage patients in primary care improvement persists. Purpose: Recognizing a continuum of forms of engagement, this study focused on identifying lessons for optimizing patient partnerships, wherein engagement is characterized by shared decision-making and practice improvement codesign. Methodology: Twenty-three semistructured interviews with providers and patients involved in improvement efforts in seven U.S. primary care practices in the Academic Innovations Collaborative (AIC). The AIC aimed to implement primary care improvement, emphasizing patient engagement in the process. Data were analyzed thematically. Results: Sites varied in their achievement of patient partnerships, encountering material, technical, and sociocultural obstacles. Time was a challenge for all sites, as was engaging a diversity of patients. Technical training on improvement processes and shared learning "on the job" were important. External, organizational, and individual-level resources helped overcome sociocultural challenges: The AIC drove provider buy-in, a team-based improvement approach helped shift relationships from providers and recipients toward teammates, and individual qualities and behaviors that flattened hierarchies and strengthened interpersonal relationships further enhanced "teamness." A key factor influencing progress toward transformative partnerships was a strong shared learning journey, characterized by frequent interactions, proximity to improvement decision-making, and learning together from the "lived experience" of practice improvement. Teams came to value not only patients' knowledge but also changes wrought by working collaboratively over time. Conclusion: Establishing practice improvement partnerships remains challenging, but partnering with patients on improvement journeys offers distinctive gains for high-quality patient-centered care. Practice Implications: Engaging diverse patient partners requires significant disruption to organizational norms and routines, and the trend toward team-based primary care offers a fertile context for patient partnerships. Material, technical, and sociocultural resources should be evaluated not only for whether they overcome specific challenges but also for how they enhance the shared learning journey. [ABSTRACT FROM AUTHOR]