The University of Southampton
University of Southampton Institutional Repository

Embedding effective depression care: using theory for primary care organisational and systems change

Gunn, Jane M., Palmer, Victoria J., Dowrick, Christopher F., Herrman, Helen E., Griffiths, Frances E., Kokanovic, Renata, Blashki, Grant A., Hegarty, Kelsey L., Johnson, Caroline L., Potiriadis, Maria and May, Carl R. (2010) Embedding effective depression care: using theory for primary care organisational and systems change Implementation Science, 5, 62-[15]. (doi:10.1186/1748-5908-5-62).

Record type: Article


Background: depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting.

Methods: we used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development.

Results: five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that agreement is reached about how care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences.

Conclusions: ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depression

PDF Embedding_effective_depression_care.pdf - Version of Record
Download (972kB)

More information

Published date: August 2010


Local EPrints ID: 177199
PURE UUID: 16b0ee51-1365-4d96-a1c4-e7cb5847b70e
ORCID for Carl R. May: ORCID iD

Catalogue record

Date deposited: 16 Mar 2011 09:45
Last modified: 18 Jul 2017 12:06

Export record



Author: Jane M. Gunn
Author: Victoria J. Palmer
Author: Christopher F. Dowrick
Author: Helen E. Herrman
Author: Frances E. Griffiths
Author: Renata Kokanovic
Author: Grant A. Blashki
Author: Kelsey L. Hegarty
Author: Caroline L. Johnson
Author: Maria Potiriadis
Author: Carl R. May ORCID iD

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton:

ePrints Soton supports OAI 2.0 with a base URL of

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.