Participatory implementation research in the field of migrant health: Sustainable changes and ripple effects over time.

Maria E T C Van Den Muijsenbergh,Anne Macfarlane,Michelle Brouwer,Parmida Shahiri,Chris Dowrick,Maria Papadakaki,Mohammed Hussain,Christos Lionis,Joseph W Lemaster

doi:10.1111/hex.13034

Abstract

ObjectiveThis study aimed to explore whether positive impacts were sustained and unanticipated ripple effects had occurred four years after the implementation of interventions to improve cross‐cultural communication in primary care.BackgroundSustaining the implementation of change using complex interventions is challenging. The EU‐funded “RESTORE” study implemented guidelines and training on cross‐cultural communication in five Primary Care sites in Europe, combining implementation theory (Normalisation Process Theory) with participatory methodology (participatory learning and action—PLA). There were positive impacts on knowledge, skills and clinical routines.Design, setting and participantsFour of the five original sites (England, Ireland, Greece, The Netherlands) were available for this qualitative follow‐up study. The study population (N = 44) was primary healthcare staff and migrants, most of whom had participated in RESTORE.Intervention; main outcome measuresPLA‐style focus groups and interviews explored routine practice during consultations with migrants. Etic cards based on the effects of RESTORE stimulated the discussion. Deductive framework analysis was performed in each country followed by comparative data analysis and synthesis.ResultsChanges in knowledge, attitudes and behaviour with regard to consultations with migrants were sustained and migrants felt empowered by their participation in RESTORE. There were ongoing concerns about macro level factors, like the political climate and financial policies, negatively affecting migrant healthcare.ConclusionThere were sustained effects in clinical settings, and additional unanticipated positive ripple effects, due in part, from the participatory approach employed.

Highlights

There are complex relationships between research, policy and practice in primary care, as well as increasing attention to translational gaps between them.[1]
We found some qualitative evidence of sustained changes in clinical settings, and additional unanticipated positive ripple effects, as well as positive regard for the participatory approach employed
We provide results of a follow-up study of an earlier investigation that combined normalization process theory (NPT) with participatory learning and action (PLA) in primary care implementation research

Summary

| INTRODUCTION

There are complex relationships between research, policy and practice in primary care, as well as increasing attention to translational gaps between them.[1]. This is the case with groups such as migrants who traditionally are underrepresented in PPI and in decision making in primary care.[17] It has the capability to engage participants in a collegial, inclusive and active processes This enables their authentic perspectives to emerge clearly in research outcomes.[18,19] The approach requires a specific PLA mode of engagement, which promotes values of reciprocity, mutual respect, co-operation and dialogue within and across diverse stakeholder groups.[20] PLA techniques (see Table 2) are inclusive and user-friendly. These matters have not yet been explored in relation to RESTORE and warrant investigation

| Aims and objectives

| METHODS

Section 2. Changes relating to clinical practice

| Study participants

| DISCUSSION

| CONCLUSIONS