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Table 3 Community participation in primary healthcare: identifying actions to improve implementation using normalisation process theory and participatory learning and action research

From: Learning from doing: the case for combining normalisation process theory and participatory learning and action research methodology for primary healthcare implementation research

NPT Construct NPT informed questions re community participation in primary healthcare explored in PLA fieldwork Problems in the practice of community participation in primary healthcare identified with stakeholders during PLA fieldwork that impact on implementation Recommended actions
Coherence How is service user involvement defined? Multiple terms are in use. People use the same terms to mean different things. There is lack of shared understanding about the work involved across stakeholders. All stakeholders clarify their own understanding of community participation in primary healthcare and, through dialogue with each other, arrive at a shared understanding of community participation in primary healthcare with other stakeholders at the start of a community participation project.
Cognitive Participation Why do stakeholders get involved? There is a lack of clarity about why different stakeholders get involved. People get involved for different reasons and there is a lack of understanding about the roles that people play. Stakeholders work together to clarify who needs to be involved and agree to work together to drive the implementation of a community participation in primary care project forward.
Collective Action What methods are used? Involvement can be tokenistic. There is often a lack of adequate resources and skills to do the work meaningfully. Stakeholders are not clear about their individual roles. All stakeholders should have appropriate organisational support, skills and training, trust in the work and the ability to perform all tasks involved in order to make an activity or process take place.
Reflexive Monitoring What are the outcomes? It is difficult to evaluate the impact of community participation in primary healthcare. Evaluation is often ad hoc and/or anecdotal. Stakeholders will appraise their work, using formal and informal systems, so that they can learn about what is working well and can modify work practices to maximize community participation in primary healthcare.
  1. Adapted from: MacFarlane, A., Tierney, E. and McEvoy, R. (2014) A Framework for Implementation of Community Participation in Primary Care; A University of Limerick and Health Service Executive Collaboration. 2014