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Implementation, context and complexity

Implementation, context and complexity
Implementation, context and complexity
Background: Context is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice.

Discussion: We present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems.

Conclusion: Implementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of ‘real world’ contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants’ discretion over resource mobilisation and actors’ contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems.
1-12
May, Carl R.
17697f8d-98f6-40d3-9cc0-022f04009ae4
Johnson, Mark
64135487-45a1-46a6-a34b-595143e3c9a6
Finch, Tracy
b1916307-8516-4b70-8ba5-05d3310839de
May, Carl R.
17697f8d-98f6-40d3-9cc0-022f04009ae4
Johnson, Mark
64135487-45a1-46a6-a34b-595143e3c9a6
Finch, Tracy
b1916307-8516-4b70-8ba5-05d3310839de

May, Carl R., Johnson, Mark and Finch, Tracy (2016) Implementation, context and complexity. Implementation Science, 11 (141), 1-12. (doi:10.1186/s13012-016-0506-3).

Record type: Article

Abstract

Background: Context is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice.

Discussion: We present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems.

Conclusion: Implementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of ‘real world’ contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants’ discretion over resource mobilisation and actors’ contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems.

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More information

Accepted/In Press date: 7 October 2016
e-pub ahead of print date: 19 October 2016
Published date: 19 October 2016
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 401833
URI: http://eprints.soton.ac.uk/id/eprint/401833
PURE UUID: 4028c92e-65dc-4f82-ac43-05e92d399145
ORCID for Carl R. May: ORCID iD orcid.org/0000-0002-0451-2690

Catalogue record

Date deposited: 21 Oct 2016 14:00
Last modified: 15 Mar 2024 02:56

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Contributors

Author: Carl R. May ORCID iD
Author: Mark Johnson
Author: Tracy Finch

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