The role of the organisational context in the implementation of a complex mental health intervention

Abstract

Abstract Introduction The 2021 framework for complex interventions introduced by the UK Medical Research Council highlights context as one of the core elements. In the implementation phase, context is considered especially critical as it affects the intervention’s effect, sustainability, and transferability. However, in public health implementation research, there is a lack of understanding of the interrelatedness between intervention and context conditions. This study aimed to explore the role of the organisational context in implementing a complex mental health intervention. Methods The study was designed as an ethnographic case study. This design enabled a comprehensive exploration of the relation between the case and its context by providing insights into the process of change implied in the implementation and how this collides with the organisational norms, culture, and structure. Four general practices participating in The Healthy Mind Intervention were included as cases. One-person interviews with clinic owners, focus group interviews with personnel, and observations of intervention activities and everyday life in the practices were used to collect data. Results Three themes were identified. First, existing organisational norms, ideals, and values were replicated in the implementation process and either inhibited or facilitated the process of change. Second, different narratives of both implementation and context existed among some of the professional groups, which complicated the collaborative efforts in the implementation. Last, conflicts in the organisations were actualised in the implementation process, which enabled a discussion and improvement of these issues. Conclusions Ethnographic case studies provide extensive insights into the role of the organizational context in implementing complex interventions, which is critical for the implementation to be effective, qualified, and sustainable.