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peer-reviewed, National and international health policies recognise that communities should be centrally involved in shaping primary healthcare services. Using Normalisation Process Theory (NPT) this study is designed to critically explore the levers and barriers to implementing community participation in primary healthcare as a routine way of working in the Health Service Executive (HSE). A qualitative systematic review of peer-reviewed literature using NPT was completed, as was a review of the ‘service user involvement’ academic literature in primary care following the principles of a critical interpretive synthesis. A qualitative case study methodology involving a review of documents, interviews and focus groups with key informants involved in the case of the Irish ‘Joint Community Participation in Primary Care Initiative’ was also carried out. All data were analysed using NPT constructs as the basis for thematic analysis. Findings were validated through data analysis clinics and feedback sessions with participants. Researchers and practitioners alike continue to debate models, approaches, definitions and operational challenges of community participation in primary healthcare and as a policy ideal its enactment proves problematic. For many participants community participation in primary healthcare is considered to be a new and valuable way of working. Champions were seen as integral to this work, as is the need for all stakeholders involved to have a clear, shared understanding of the aims, objectives and benefits of this way of working. The need for strong partnerships was also reiterated, with some participants identifying the benefits of established relational interactions in sustaining this type of work. This study shows that NPT, whilst a new theory, provides a generalisable framework that can be applied across contexts and potentially shape implementation journeys. Findings from this NPT analysis were further used to create a theoretically informed framework to support th

peer-reviewed, Background: Many international health policies recognise the World Health Organization’s (2008) vision that communities should be involved in shaping primary healthcare services. However, researchers continue to debate definitions, models, and operational challenges to community participation. Furthermore, there has been no use of implementation theory to study how community participation is introduced and embedded in primary healthcare in order to generate insights and transferrable lessons for making this so. Using Normalisation Process Theory (NPT) as a conceptual framework, this qualitative study was designed to explore the levers and barriers to the implementation of community participation in primary healthcare as a routine way of working. Methods: We conducted two qualitative studies based on a national Initiative designed to support community participation in primary care in Ireland. We had a combined multi-stakeholder purposeful sample (n = 72), utilising documentary evidence (study 1), semi-structured interviews (studies 1 and 2) and focus groups (study 2). Data generation and analysis were informed by Participatory Learning and Action (PLA) Research Methodology and NPT. Results: For many stakeholders, community participation in primary healthcare was a new way of working. Stakeholders did not always have a clear, shared understanding of the aims, objectives and benefits of this way of working and getting involved in a specific project sometimes provided this clarity. Drivers/champions, and strong working partnerships, were considered integral to its initiation and implementation. Participants emphasised the benefits of funding, organisational support, training and networking to enact relevant activities. Health-promoting activities and healthcare consultation/information events were generally successful, but community representation on interdisciplinary Primary Care Teams proved more challenging. Overall, participants were broadly positive about the impac

peer-reviewed, Background: Community participation in primary care is enshrined in international and Irish health policy. However, there is a lack of evidence about how stakeholders work collectively to implement community participation within interdisciplinary teams; community perspectives are rarely captured, and a theoretical underpinning for implementation of community participation in primary care is absent. Objective: To conduct a theoretically informed, multiperspectival empirical analysis of the implementation of community participation via primary care teams (PCTs) in Ireland. Methods/Design/Participants: Participatory learning and action (PLA) focus groups and interviews were held with 39 participants across four case study sites within a nationally funded programme designed to enable disadvantaged communities to participate in primary care. Normalization process theory (NPT) informed data generation and analysis of how diverse stakeholder groups worked together to implement community participation via PCTs. Results: The various stakeholders had a shared understanding of the value of community participation on PCTs. Motivations to get involved in this work varied, but were strong overall. Challenges to enacting community participation on PCTs included problems with the functioning of PCTs and a lack of clarity and confidence in the role of community representatives at PCT meetings. Informal appraisals were positive, but formal appraisal was limited. Discussion and Conclusion: The implementation and sustainability of community participation on PCTs in Ireland will be limited unless (i) the functioning of PCTs is strong, (ii) there is increased confidence and clarity on community representatives’ roles among all health-care professionals, and (iii) more sophisticated methods for formal appraisal are used.

peer-reviewed, Background: There is a well-recognized need for greater use of theory to address research translational gaps. Normalization Process Theory (NPT) provides a set of sociological tools to understand and explain the social processes through which new or modified practices of thinking, enacting, and organizing work are implemented, embedded, and integrated in healthcare and other organizational settings. This review of NPT offers readers the opportunity to observe how, and in what areas, a particular theoretical approach to implementation is being used. In this article we review the literature on NPT in order to understand what interventions NPT is being used to analyze, how NPT is being operationalized, and the reported benefits, if any, of using NPT. Methods: Using a framework analysis approach, we conducted a qualitative systematic review of peer-reviewed literature using NPT. We searched 12 electronic databases and all citations linked to six key NPT development papers. Grey literature/unpublished studies were not sought. Limitations of English language, healthcare setting and year of publication 2006 to June 2012 were set. Results: Twenty-nine articles met the inclusion criteria; in the main, NPT is being applied to qualitatively analyze a diverse range of complex interventions, many beyond its original field of e-health and telehealth. The NPT constructs have high stability across settings and, notwithstanding challenges in applying NPT in terms of managing overlaps between constructs, there is evidence that it is a beneficial heuristic device to explain and guide implementation processes. Conclusions: NPT offers a generalizable framework that can be applied across contexts with opportunities for incremental knowledge gain over time and an explicit framework for analysis, which can explain and potentially shape implementation processes. This is the first review of NPT in use and it generates an impetus for further and extended use of NPT. We recommend that in futur

peer-reviewed, National and international health policies recognise that communities should be centrally involved in shaping primary healthcare services. Using Normalisation Process Theory (NPT) this study is designed to critically explore the levers and barriers to implementing community participation in primary healthcare as a routine way of working in the Health Service Executive (HSE). A qualitative systematic review of peer-reviewed literature using NPT was completed, as was a review of the ‘service user involvement’ academic literature in primary care following the principles of a critical interpretive synthesis. A qualitative case study methodology involving a review of documents, interviews and focus groups with key informants involved in the case of the Irish ‘Joint Community Participation in Primary Care Initiative’ was also carried out. All data were analysed using NPT constructs as the basis for thematic analysis. Findings were validated through data analysis clinics and feedback sessions with participants. Researchers and practitioners alike continue to debate models, approaches, definitions and operational challenges of community participation in primary healthcare and as a policy ideal its enactment proves problematic. For many participants community participation in primary healthcare is considered to be a new and valuable way of working. Champions were seen as integral to this work, as is the need for all stakeholders involved to have a clear, shared understanding of the aims, objectives and benefits of this way of working. The need for strong partnerships was also reiterated, with some participants identifying the benefits of established relational interactions in sustaining this type of work. This study shows that NPT, whilst a new theory, provides a generalisable framework that can be applied across contexts and potentially shape implementation journeys. Findings from this NPT analysis were further used to create a theoretically informed framework to support th

peer-reviewed, There are now several decades of history of community participation in health, with significant international evidence to suggest that there is much to be gained by primary health services and disadvantaged communities working in partnership. In this paper we provide an overview of community participation in primary care, establishing the policy context in which a recent ‘Joint Initiative on Community Participation in Primary Health Care’ was developed in Ireland. This Initiative was designed to support the involvement of disadvantaged communities and groups in the development of primary health care services at local level. An independent formative evaluation of the Joint Initiative took place between September 2009 and April 2010. We present a summary of key findings from this evaluation. We pay particular attention to the issue of sustaining community participation in newly developed Primary Care Teams (PCTs) in the current and changing economic climate, an issue considered crucial if the documented positive impacts of the Joint Initiative are to be maintained and the potential for health gains in the longer term are to be realised. We then argue that the Joint Initiative referred to in this paper clearly provides a strong prototype for community participation in PCTs in Ireland. We also ask whether it can be replicated across all PCTs in the country and embedded as a core part of thinking and everyday health care. We highlight the need for research to build knowledge about the ways in which innovations such as this can be embedded into ongoing, routine healthcare practice. This research agenda will have relevance for policy makers, practitioners and evaluators in Ireland and other healthcare jurisdictions.