Analysis of data in RESTORE using NPT.Professor Kate O’DonnellFor the RESTORE team NPT training April 2013.

Aim of this presentation

• To think about our approach to analysis using NPT.• To build on the work already started.• To work through our recent example.• To plan or next steps .......

RESTORE Aim.

To optimise the delivery of primary healthcare to European citizens who are migrants and experiencing language and cultural barriers in their host countries.

How?

By carrying out research into the implementation of evidence-based health information designed to address language and cultural barriers in primary care settings in Europe.

Data generation.

SASI and CAPES sessions.Rich, qualitative data in the form of • Commentary charts.• Seasonal calendars.• Interviews and group session transcripts.• Reports including CAPES reports.

Approaches to qualitative data analysis.

Bottom-up, grounded and immersed in the data.Grounded theory approach (analysis as part of the research

approach).Thematic analysis.Guided by interview schedule – but with room for emergent themes.Framework approach – policy analysis.Driven by application of a theoretical framework.

Data analysis in RESTORE.

Pragmatically and theoretically driven........

Pragmatically driven.

Huge quantities of data generated.Work situated in 6 countries.Generated in at least 4 languages.In our study protocol (Macfarlane et al. Implementation

Science 2012; 7: 111. http://www.implementationscience.com/content/pdf/1748-5908-7-111.pdf)

Theoretically driven.

Offers a generalisable framework that can be applied across settings and individuals.

Offers the opportunity for the incremental accumulation of knowledge.

Offers an explicit framework for analysis.

Eccles et al. Implementation Science 2009; 4: 18.

Why NPT?• Focuses on the work that individuals and groups have

to do for a new technology/practice/way of working to become embedded and sustained in routine practice.

• About both implementation and routinisation.

“Helps us to identify and understand factors which promote and inhibit the routine incorporation of complex interventions in everyday practice.”

Murray et al. BMC Medicine 2010.

WIDE

• Initial meetings to establish stakeholder group(s).

• NPT was introduced to all

SASI

• Used NPT to help screen identified G/TIs

• Offered basket of 3-6 G/TIs to stakeholders

CAPES

• NPT will help to inform the areas you need to explore with stakeholders.

• NPT will inform analysis of data generated during CAPES

Mapping Exercise took place

Preparatory exercise: Coding of DVD transcript.

Idea from Nijmegen.Transcript exercise from CAPES DVD.Asked members of NPT training team and each partner country to

code.Coding at least to “big 4” constructs.Also sent to 3 NPT experts.

Coding of DVD transcript.

http://www.gettyimages.co.uk/detail/photo/crowd-of-people-clapping-and-cheering-high-res-stock-photography/92632769

Remember .....RESTORE imposes a temporal order on the data collectionOK to be focussed on coherence and cognitive

participation in the early stages.But remember collective action and reflexive

monitoring.The constructs merge, depending on “thinking about” or

“doing” the doing.OK to multiply code chunks of text.

NPT Constructs.

Construct What it addressesCoherence Can stakeholders make sense of it?

Cognitive Participation Can stakeholders get others involved and engaged in it?

Collective Action What has to be done to make it work in routine practice?

Reflexive Monitoring How can it be monitored and evaluated?

Coherence Cognitive Participation

Collective ActionReflexive

Monitoring

Thinking about doing

Doing the doing

Can stakeholders make senseof the G/TI presented?

Things to consider in CAPES:

Is this a new way of working?Is it very different from how things are currently done? If yes, how?Does everyone have the same view about what the G/TI is trying to achieve? And about what the benefits might be?Can the stakeholders talk about what might have to be done to implement this in practice?Can they see potential benefits of this G/Ti for them?

Coherence

Can stakeholders engage with the implementing the G/Ti?Can they get others involved?

Things to consider in CAPES:

Do the stakeholders think they are the right people to be driving the implementation of the G/Ti?Are the stakeholders willing, and able, to get others involved in implementing the G/Ti?Can the stakeholders work together to implement the G/Ti?Can the stakeholders identify what actions and activities will be needed to sustain the new work described in the G/Ti?

Cognitive Participation

In practice, what activities will promote or hinder the implementation of the G/Ti?

Things to consider in CAPES:

Will stakeholders (or others involved in implementation) be able to perform the tasks suggested by the G/Ti?Will it be better than their usual way of working?Will those involved in implementation maintain their trust in each other’s work and expertise?Will those allocated the work have the right range of skills and training to do the job?Will implementation be supported by management and other groups?Will implementation be supported by training, money, national or local policy? Collective

Action

How will stakeholders judge and monitor the implementation of the G/TI and its effects on practice?

Things to consider in CAPES:

Will stakeholders be able to judge the effectiveness and usefulness of the G/Ti in their local setting?How will they do this?What will they do with the information generated?Will they try to adapt or modify what they are doing?

Reflexive Monitoring

Paragraph 2: Policy maker

• “Yeah, I suppose just reflecting on where we are at, at the moment within the health organisation is that we have a ban on travel and there’s an embargo on education and training initiatives. So something like this that provides a DVD, training and guidance is a major plus. Its something that’s really going to tick the boxes for us whilst be very meaningful for front line staff as well”

All focused on coherence – making sense of it.

Paragraph 2: Policy maker

• “Yeah, I suppose just reflecting on where we are at, at the moment within the health organisation is that we have a ban on travel and there’s an embargo on education and training initiatives. So something like this that provides a DVD, training and guidance is a major plus. Its something that’s really going to tick the boxes for us whilst be very meaningful for front line staff as well”

• very meaningful for front line staff as well

Coherence, but moving onto tasks (collective action); overlaps with engaging others (cognitive participation).

Paragraph 4: GP

• “Yeah I think this was mine here, so as a GP I really liked the fact that there was a resource available to me as a front line member of staff, a resource available to me which answers a lot of the questions that I have about using interpreters in my practice and how that might work. So I found that very helpful.”

Focus on coherence.

Paragraph 6: Interpreter

• “Yeah I think that one there [name] that you pointed to is my one and as an interpreter I felt that this package was particularly relevant because it gives special attention to the Irish context and I feel that that’s very important for me in my role as an interpreter. And that you know for interpreters working in Ireland that its just very useful, I don’t think this has been done before.”

Mix of coherence and collective action (mention of context maps to contextual integration).

Paragraph 10: Migrant user

• “Yeah there’s a comment there and what I have there is I like that the training is linked to a particular set of guidelines, I thought it was rather unusual first of all that here’s a training program and yet it’s a training program in how to work with an interpreter but it also provides a set of guidelines.”

Mainly maps to coherence, but could code the “how to work with an interpreter” to collective action – depends on temporal order to data collection to implementation journey.

Paragraph 12: Migrant user

• “Within it, yeah. So the training is for using this set of guidelines, so I thought that was really, I am a migrant rep as well so I'm fairly familiar with the kind of guidelines that are out there and guidances, and that’s rather unusual and I really liked that”

Focus on coherence – how this guideline is different to others that he knows about.

Paragraph 16: Interpreter

• “Yeah, I have this one here Mary, I guess I really liked the fact that it took account of different scenarios, different situations, different contexts. So for example it talks about being an interpreter and using interpretation over the phone, face to face situations or in mental health settings. So I suppose it reflects real life that it doesn’t just happen in one scenario at one place or one point in time. So I thought that was very good.

Mainly coherence, but also some collective action.

Paragraph 18: GP

• “I had a question there just about how user friendly the DVD is so for example would I be able to play this DVD in my computer that I have in my office, in my practice. Or would I have to go and get a DVD player and a separate television in order to play it and that would really affect my implementation of it and influence whether or not I would use this DVD. So that wasn’t clear to me just as I was reading that.”

Multiple coding here – coherence; cognitive participation; and a lot of collective action.

Paragraph 20: GP

• “Which would mean a lot you know in my practice because the computer is there and I don’t have to go rooting around and it would save time”

Mainly collective action – what the GP needs to do to use this resource.

Paragraph 24: Migrant

• “Yeah, I have one there. Again just thinking from the perspective of a migrant that okay the training is very much directed towards service providers, which is great and terrific. But I'm just wondering is there room for us migrants to receive training in some form as well related to this? Because it could be very useful and so it just, are we included in that kind of training is my question I suppose?”

And here – coherence; cognitive participation; and a lot of collective action.

Acknowledgements.

RESTORE was funded by the European Union’s FP7 Health Programme, contract number 257258.

The work was led by Professor Anne MacFarlane, University of Limerick, Eire.

This presentation was delivered to the RESTORE team in April 2013.

http://www.fp7restore.eu/

NPT Training for the RESTORE project.

This presentation was designed and delivered by:

Professors Kate O’Donnell and Frances Mair, University of Glasgow, Scotland.

Professor Christopher Dowrick, University of Liverpool, England.

Professor Anne MacFarlane, University of Limerick, Eire.

For further information, contact: Kate.O’Donnell@glasgow.ac.uk