title: Learning from doing: the case for combining normalisation process theory and participatory learning and action research methodology for primary healthcare implementation research.
abstract: The implementation of research findings is not a straightforward matter. There are substantive and recognised gaps in the process of translating research findings into practice and policy. In order to overcome some of these translational difficulties, a number of strategies have been proposed for researchers. These include greater use of theoretical approaches in research focused on implementation, and use of a wider range of research methods appropriate to policy questions and the wider social context in which they are placed. However, questions remain about how to combine theory and method in implementation research. In this paper, we respond to these proposals.
  
  
  
  Focussing on a contemporary social theory, Normalisation Process Theory, and a participatory research methodology, Participatory Learning and Action, we discuss the potential of their combined use for implementation research. We note ways in which Normalisation Process Theory and Participatory Learning and Action are congruent and may therefore be used as heuristic devices to explore, better understand and support implementation. We also provide examples of their use in our own research programme about community involvement in primary healthcare.
  
  
  
  Normalisation Process Theory alone has, to date, offered useful explanations for the success or otherwise of implementation projects post-implementation. We argue that Normalisation Process Theory can also be used to prospectively support implementation journeys. Furthermore, Normalisation Process Theory and Participatory Learning and Action can be used together so that interventions to support implementation work are devised and enacted with the expertise of key stakeholders. We propose that the specific combination of this theory and methodology possesses the potential, because of their combined heuristic force, to offer a more effective means of supporting implementation projects than either one might do on its own, and of providing deeper understandings of implementation contexts, rather than merely describing change.
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland. tomas.debrun@nuigalway.ie.
authors.forename: Tomas
authors.initials: T
authors.lastname: de Brún
authors.affiliation: Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: O'Reilly-de Brún
authors.affiliation: General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: O'Donnell
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: Anne
authors.initials: A
authors.lastname: MacFarlane
mesh_terms: D006302:Health Services Research; D006801:Humans; D008962:Models, Theoretical; D011320:Primary Health Care; D036301:Qualitative Research; D012107:Research Design
keywords: Implementation research; Normalisation process theory; Primary  healthcare, participatory learning & action research; Theoretical frameworks