Participatory implementation research in the field of migrant health: Sustainable changes and ripple effects over time

• Published in: Health expectations : an international journal of public participation in health care and health policy Vol. 23; no. 2; pp. 306 - 317
• Main Authors: Muijsenbergh, Maria E. T. C., LeMaster, Joseph W., Shahiri, Parmida, Brouwer, Michelle, Hussain, Mohammed, Dowrick, Chris, Papadakaki, Maria, Lionis, Christos, MacFarlane, Anne
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-04-2020; John Wiley and Sons Inc; Wiley
• Subjects: Attitudes; Change agents; Changes; Clinical decision making; Clinical skills; Communication; Data analysis; Decision making; Effects; Environmental policy; Health care; Implementation; Information management; Innovations; Intervention; Knowledge; Learning; Medical research; migrant health; Migrants; normalisation process theory; Original Research Paper; Original Research Papers; participatory learning and action methods; patient and public involvement; Political factors; Population studies; Primary care; Ripples; Stakeholders; Theory; Greece; England; Netherlands; United Kingdom > UK; Ireland; participatory learning and action methods; migrant health; normalisation process theory; primary care; patient and public involvement; implementation
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1111/hex.13034

Objective
This study aimed to explore whether positive impacts were sustained and unanticipated ripple effects had occurred four years after the implementation of interventions to improve cross‐cultural communication in primary care.
Background
Sustaining the implementation of change using complex interventions is challenging. The EU‐funded “RESTORE” study implemented guidelines and training on cross‐cultural communication in five Primary Care sites in Europe, combining implementation theory (Normalisation Process Theory) with participatory methodology (participatory learning and action—PLA). There were positive impacts on knowledge, skills and clinical routines.
Design, setting and participants
Four of the five original sites (England, Ireland, Greece, The Netherlands) were available for this qualitative follow‐up study. The study population (N = 44) was primary healthcare staff and migrants, most of whom had participated in RESTORE.
Intervention; main outcome measures
PLA‐style focus groups and interviews explored routine practice during consultations with migrants. Etic cards based on the effects of RESTORE stimulated the discussion. Deductive framework analysis was performed in each country followed by comparative data analysis and synthesis.
Results
Changes in knowledge, attitudes and behaviour with regard to consultations with migrants were sustained and migrants felt empowered by their participation in RESTORE. There were ongoing concerns about macro level factors, like the political climate and financial policies, negatively affecting migrant healthcare.
Conclusion
There were sustained effects in clinical settings, and additional unanticipated positive ripple effects, due in part, from the participatory approach employed.