Reeve, Joanne L., Cooper, L., Harrington, S., Rosbottom, P. and Watkins, J. (2016) Developing, delivering and evaluating primary mental health care : the co-production of a new complex intervention. BMC Health Services Research, 16 . 470. doi:10.1186/s12913-016-1726-6

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Abstract

Background:
Health services face the challenges created by complex problems, and so need complex intervention solutions. However they also experience ongoing difficulties in translating findings from research in this area in to quality improvement changes on the ground. BounceBack was a service development innovation project which sought to examine this issue through the implementation and evaluation in a primary care setting of a novel complex intervention.

Methods:
The project was a collaboration between a local mental health charity, an academic unit, and GP practices. The aim was to translate the charity’s model of care into practice-based evidence describing delivery and impact. Normalisation Process Theory (NPT) was used to support the implementation of the new model of primary mental health care into six GP practices. An integrated process evaluation evaluated the process and impact of care.

Results:
Implementation quickly stalled as we identified problems with the described model of care when applied in a changing and variable primary care context. The team therefore switched to using the NPT framework to support the systematic identification and modification of the components of the complex intervention: including the core components that made it distinct (the consultation approach) and the variable components (organisational issues) that made it work in practice. The extra work significantly reduced the time available for outcome evaluation. However findings demonstrated moderately successful implementation of the model and a suggestion of hypothesised changes in outcomes.

Conclusions:
The BounceBack project demonstrates the development of a complex intervention from practice. It highlights the use of Normalisation Process Theory to support development, and not just implementation, of a complex intervention; and describes the use of the research process in the generation of practice-based evidence. Implications for future translational complex intervention research supporting practice change through scholarship are discussed.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Mental health services, Physicians (General practice)
Journal or Publication Title:	BMC Health Services Research
Publisher:	Biomed central
ISSN:	1472-6963
Official Date:	6 September 2016
Dates:	Date Event 6 September 2016 Available 27 August 2016 Accepted 2 October 2015 Submitted
Volume:	16
Article Number:	470
DOI:	10.1186/s12913-016-1726-6
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	Great Britain. Department of Health (DoH)
Grant number:	Innovation Excellence and Strategic Development fund grant (2532287
Related URLs:	Publisher

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