Using normalisation process theory (NPT) to explore implementation of the maternal perinatal death surveillance and response (MPDSR) policy in Uganda: a reflection.

IF 3.6 2区 医学 Q1 HEALTH POLICY & SERVICES
David Roger Walugembe, Katrina Plamondon, Frank Kaharuza, Peter Waiswa, Lloy Wylie, Nadine Wathen, Anita Kothari
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Abstract

Background: The implementation of the maternal perinatal death surveillance and response (MPDSR) policy is among the envisaged strategies to reduce the high global burden of maternal and perinatal mortality and morbidity. However, implementation of this policy across various contexts is inconsistent. Theoretically informed approaches to process evaluation can support assessment the implementation of policy interventions such as MPDSR, particularly in understanding what the actors involved actually do. In this article, we reflect on how the normalisation process theory (NPT) was used to explore implementation of the MPDSR policy in Uganda. NPT is a sociological theory concerned with the social organisation of the work (implementation) of making practices routine elements of everyday life (embedding) and of sustaining embedded practices in their social contexts (integration).

Methods: This qualitative multiple case study conducted across eight districts in Uganda and among 10 health facilities (cases) representing four out of the seven levels of the Uganda health care system. NPT was utilised in several ways including informing the study design, structuring the data collection tools (semi-structured interview guides), providing an organising framework for analysis, interpreting and reporting of study findings as well as making recommendations. Study participants were purposely selected to reflect the range of actors involved in the policy implementation process. This included direct care providers located at each of the cases, the Ministry of Health and from agencies and professional associations. Data were collected using semi-structured, in-depth interviews and were inductively and deductively analysed using NPT constructs and subconstructs.

Results and conclusion: NPT served useful for process evaluation, particularly in identifying factors that contribute to variations in policy implementation. Considering the NPT focus on the agency of people involved in implementation, additional efforts are required to understand how recipients of the policy intervention influence how the intervention becomes embedded within the various contexts.

利用规范化过程理论(NPT)探讨乌干达孕产妇围产期死亡监测和响应(MPDSR)政策的实施情况:反思。
背景:实施孕产妇围产期死亡监测和应对(MPDSR)政策是降低全球孕产妇和围产期死亡率和发病率高负担的预期战略之一。然而,这项政策在不同情况下的实施情况并不一致。有理论依据的过程评估方法可支持对 MPDSR 等政策干预措施的实施情况进行评估,尤其是在了解相关参与者的实际工作方面。在本文中,我们将反思如何利用正常化过程理论(NPT)来探讨 MPDSR 政策在乌干达的实施情况。NPT 是一种社会学理论,关注的是使实践成为日常生活常规要素(嵌入)以及在社会环境中维持嵌入实践(整合)的工作(实施)的社会组织:这项定性多案例研究在乌干达的八个地区和 10 个医疗机构(案例)中进行,这些医疗机构代表了乌干达医疗保健系统七个级别中的四个级别。在多个方面使用了 NPT,包括为研究设计提供信息、构建数据收集工具(半结构化访谈指南)、为分析提供组织框架、解释和报告研究结果以及提出建议。研究参与者的选择特意反映了政策实施过程中的参与者范围。其中包括每个案例中的直接护理提供者、卫生部以及各机构和专业协会。研究采用半结构化深入访谈的方式收集数据,并使用 NPT 结构和子结构对数据进行归纳和演绎分析:结果与结论:NPT 对过程评估很有用,特别是在确定造成政策执行差异的因素方面。考虑到 NPT 的重点是参与实施的人员的能动性,还需要进一步努力了解政策干预的接受者如何影响干预如何嵌入各种环境。
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来源期刊
Health Research Policy and Systems
Health Research Policy and Systems HEALTH POLICY & SERVICES-
CiteScore
7.50
自引率
7.50%
发文量
124
审稿时长
27 weeks
期刊介绍: Health Research Policy and Systems is an Open Access, peer-reviewed, online journal that aims to provide a platform for the global research community to share their views, findings, insights and successes. Health Research Policy and Systems considers manuscripts that investigate the role of evidence-based health policy and health research systems in ensuring the efficient utilization and application of knowledge to improve health and health equity, especially in developing countries. Research is the foundation for improvements in public health. The problem is that people involved in different areas of research, together with managers and administrators in charge of research entities, do not communicate sufficiently with each other.
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