title: REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings (RESTORE): study protocol.
abstract: BACKGROUND
  The implementation of guidelines and training initiatives to support communication in cross-cultural primary care consultations is ad hoc across a range of international settings with negative consequences particularly for migrants. This situation reflects a well-documented translational gap between evidence and practice and is part of the wider problem of implementing guidelines and the broader range of professional educational and quality interventions in routine practice. In this paper, we describe our use of a contemporary social theory, Normalization Process Theory and participatory research methodology--Participatory Learning and Action--to investigate and support implementation of such guidelines and training initiatives in routine practice.
  
  
  METHODS
  This is a qualitative case study, using multiple primary care sites across Europe. Purposive and maximum variation sampling approaches will be used to identify and recruit stakeholders-migrant service users, general practitioners, primary care nurses, practice managers and administrative staff, interpreters, cultural mediators, service planners, and policy makers. We are conducting a mapping exercise to identify relevant guidelines and training initiatives. We will then initiate a PLA-brokered dialogue with stakeholders around Normalization Process Theory's four constructs--coherence, cognitive participation, collective action, and reflexive monitoring. Through this, we will enable stakeholders in each setting to select a single guideline or training initiative for implementation in their local setting. We will prospectively investigate and support the implementation journeys for the five selected interventions. Data will be generated using a Participatory Learning and Action approach to interviews and focus groups. Data analysis will follow the principles of thematic analysis, will occur in iterative cycles throughout the project and will involve participatory co-analysis with key stakeholders to enhance the authenticity and veracity of findings.
  
  
  CONCLUSIONS
  This research employs a unique combination of Normalization Process Theory and Participatory Learning and Action, which will provide a novel approach to the analysis of implementation journeys. The findings will advance knowledge in the field of implementation science because we are using and testing theoretical and methodological approaches so that we can critically appraise their scope to mediate barriers and improve the implementation processes.
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland. anne.macfarlane@ul.ie
authors.forename: Anne
authors.initials: A
authors.lastname: MacFarlane
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Donnell
authors.forename: Frances
authors.initials: F
authors.lastname: Mair
authors.forename: Mary
authors.initials: M
authors.lastname: O'Reilly-de Brún
authors.forename: Tomas
authors.initials: T
authors.lastname: de Brún
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Spiegel
authors.forename: Maria
authors.initials: M
authors.lastname: van den Muijsenbergh
authors.forename: Evelyn
authors.initials: E
authors.lastname: van Weel-Baumgarten
authors.forename: Christos
authors.initials: C
authors.lastname: Lionis
authors.forename: Nicola
authors.initials: N
authors.lastname: Burns
authors.forename: Katja
authors.initials: K
authors.lastname: Gravenhorst
authors.forename: Christine
authors.initials: C
authors.lastname: Princz
authors.forename: Erik
authors.initials: E
authors.lastname: Teunissen
authors.forename: Francine
authors.initials: F
authors.lastname: van den Driessen Mareeuw
authors.forename: Aristoula
authors.initials: A
authors.lastname: Saridaki
authors.forename: Maria
authors.initials: M
authors.lastname: Papadakaki
authors.forename: Maria
authors.initials: M
authors.lastname: Vlahadi
authors.forename: Christopher
authors.initials: C
authors.lastname: Dowrick
mesh_terms: D003071:Cognition; D003142:Communication; D054521:Cultural Competency / Q000458:organization & administration*; D005060:Europe; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D033181:Information Dissemination; D007318:Inservice Training / Q000458:organization & administration; D007802:Language; D007858:Learning; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011582:Psychological Theory; D036301:Qualitative Research; D012107:Research Design