This project is concerned with optimising the delivery of primary healthcare to European citizens who are migrants and who experience language and cultural barriers in host countries. We focus on the implementation of evidence-based health information (e.g. guidelines to enhance communication in cross-cultural consultations) and interventions (e.g. training initiatives on interculturalism and the use of paid interpreters) designed to address language and cultural barriers in primary care settings. We explore how the evidence-based information is translated (or not) into routine practice in primary care settings. We investigate and support implementation processes for evidence-based health information using a unique combination of contemporary social theory, the Normalization Process Theory, and a participatory research methodology, Participatory Learning and Action.
Migration is a global phenomenon, which presents challenges for host healthcare systems. Many migrants and primary care practitioners interact with each other in primary care consultations without having a shared language or cultural background. Untrained and informal interpreters and cultural mediators are commonly used in these consultations, with evidence of negative consequences for service users from migrant communities.
This status quo reflects a gap in translating research evidence about the positive impact of trained, professionals on communication in cross cultural consultations into routine clinical practice in primary care settings. It is important that health researchers address this translational gap in order to improve migrants’ access to, and experiences of, culturally competent healthcare in their host countries.
RESTORE focuses on learning from the implementation of guidelines and/or training initiatives to support the use of professional interpreters and/or cultural mediators to support communication in cross-cultural primary care consultations.
D2.1 Initial report on NPT and PLA training and outline of planned phased training
In RESTORE, we apply a unique combination of theory and method in the field of implementation science to address a translational gap between evidence and practice for cross-cultural consultations in primary care. We use a contemporary social theory, Normalisation Process Theory (NPT), and a participatory research methodology, Participatory Learning and Action (PLA). In order to ensure the effectiveness of our research, all researchers involved in project fieldwork should have a robust knowledge of and appropriate skill sets to employ NPT and PLA in their local settings.
Therefore, RESTORE has delivered a comprehensive training component (in WP2). D2.1 describes the initial residential training week in NPT and PLA for the RESTORE consortium, held in Galway, Ireland in late 2011 (photo below). We conducted evaluations of the NPT and PLA training received and have used this to inform our subsequent training which:
D3.1 Report on WP3 Mapping Process Examples of Guidances and/or Training initiatives to support communication in cross-cultural primary care consultations in Ireland, the Netherlands, Greece, England, Austria, and Scotland.
The goal of WP3 is to engage and involve stakeholders in an exploration of the implementation of supports (training initiatives and guidelines) for cross-cultural consultations that are potentially relevant to their specific settings. Deliverable D3.1 summarised the mapping process carried out by RESTORE partners in Ireland, the Netherlands, Greece, England, Austria and Scotland (photo below). It included twenty examples of guidances and/or training initiatives that support communication in cross-cultural primary care consultations.
Deliverable D4.1 Intervention portfolio (portfolio of co-designed interventions for implementation by participants in their local settings.
Following the WP3 mapping process, the project entered the main phase of fieldwork with stakeholders in each setting. In WP4, we used NPT to select a set of implementable guidances or training initiatives for each setting. Stakeholders in each country then engaged in a series of meetings together and used a PLA technique called Direct Ranking to democratically select one G/TI as the implementation project for their local setting (photo below). These activities realate to NPT constructs Coherence and Cognitive Participation.Full details of this process and the final set of selected guidances and training initiatives is described in D4.1.
The task of implementing the selected guidances and training initiatives started in each country early in 2013 and is now well underway. Throughout WP5 and WP6, we are following the stakeholders’ implementation journeys with specific attention to NPT constructs about Collective Action and Reflexive Monitoring as stakeholders seek to enact the new practice in primary care, identify formal and informal strategies to appraise and sustain its use over time. We have a particular interest in the involvement of migrants in all settings and in the involvement of undocumented migrants in the Netherlands.
We continue to use PLA techniques to stimulate learning between stakeholders and to encourage problem solving to arising barriers to the implementation work. We are generating qualitative data about the progress of the implementation journeys but, also, the ways in which NPT and PLA are being used to investigate and support these journeys.
Findings from WP5 and WP6 are due in D5.1 and D6.1 in 2015.
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