Beyond 'train and hope': Identifying factors that affect implementation of the Promotional Guide in practice

Morton, Alison and Wigley, Wendy (2014) Beyond 'train and hope': Identifying factors that affect implementation of the Promotional Guide in practice. Journal of Health Visiting, 2 (12), 670-680.

Abstract

The Healthy Child Programme recommends using the Promotional Guide to explore health needs. This paper presents the findings of a qualitative research study using normalisation process theory to identify factors that affect the implementation of the Guide. Data were collected using semi-structured interviews with health visitors (n=9) to explore their experiences of implementation. Health visitors were positive and felt the Guide enhanced their practice, but embedding it into practice was not straightforward. The multiple purposes of the antenatal appointment produced points of disjuncture. Integration was achieved only when the Guide was considered to fulfil the perceived requirements of the organisation and the client perceived the intervention as worthwhile. Factors affecting implementation included: lack of client awareness of the health visiting service; integration of client needs with organisational agenda; organisational compliance, electronic patient record and monitoring systems provided no incentive for Promotional Guide use; continuity of practitioner; health visitor communication skills; and endorsement by senior management. To minimise difficulties, it is recommended that an implementation strategy is used when introducing the Promotional Guide into health visiting practice.

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