title: A critical analysis of the implementation of service user involvement in primary care research and health service development using normalization process theory.
abstract: There have been recent important advances in conceptualizing and operationalizing involvement in health research and health-care service development. However, problems persist in the field that impact on the scope for meaningful involvement to become a routine - normalized - way of working in primary care. In this review, we focus on current practice to critically interrogate factors known to be relevant for normalization - definition, enrolment, enactment and appraisal.
  
  
  
  Ours was a multidisciplinary, interagency team, with community representation. We searched EBSCO host for papers from 2007 to 2011 and engaged in an iterative, reflexive approach to sampling, appraising and analysing the literature following the principles of a critical interpretive synthesis approach and using Normalization Process Theory.
  
  
  
  Twenty-six papers were chosen from 289 papers, as a purposeful sample of work that is reported as service user involvement in the field. Few papers provided a clear working definition of service user involvement. The dominant identified rationale for enrolling service users in primary care projects was linked with policy imperatives for co-governance and emancipatory ideals. The majority of methodologies employed were standard health services research methods that do not qualify as research with service users. This indicates a lack of congruence between the stated aims and methods. Most studies only reported positive outcomes, raising questions about the balance or completeness of the published appraisals.
  
  
  
  To improve normalization of meaningful involvement in primary care, it is necessary to encourage explicit reporting of definitions, methodological innovation to enhance co-governance and dissemination of research processes and findings.
authors: Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors: Edel
authors: E
authors: Tierney
authors: Discipline of General Practice, National University of Ireland, Galway, Ireland.
authors: Rachel
authors: R
authors: McEvoy
authors: Discipline of General Practice, National University of Ireland, Galway, Ireland.
authors: Mary
authors: M
authors: O'Reilly-de Brún
authors: Discipline of General Practice, National University of Ireland, Galway, Ireland.
authors: Tomas
authors: T
authors: de Brún
authors: Galway Migrant Service, Galway, Ireland.
authors: Ekaterina
authors: E
authors: Okonkwo
authors: Mayo Intercultural Action, Ballina, Ireland.
authors: Michelle
authors: M
authors: Rooney
authors: University of Liverpool, Primary Medical Care, Liverpool, UK.
authors: Chris
authors: C
authors: Dowrick
authors: NIHR Collaboration for Leadership in Applied Health Research and Care, Wessex, UK.|Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors: Anne
authors: A
authors: Rogers
authors: Primary Health Care Research, Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors: Anne
authors: A
authors: MacFarlane
mesh_terms: D003159:Community-Institutional Relations; D003299:Cooperative Behavior; D003695:Delivery of Health Care; D006296:Health Services; D006302:Health Services Research / Q000379:methods / Q000458:organization & administration; D006801:Humans; D007400:Interprofessional Relations; D010358:Patient Participation; D011320:Primary Health Care; D009626:Terminology as Topic
keywords: critical interpretive synthesis; normalization process theory; patient participation; primary health care; service user involvement