Implementation, context and complexity.
Implementation, context and complexity.
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DOI：
10.1186/s13012-016-0506-3
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发表时间：
2016-10-19
期刊：
影响因子：
--
通讯作者：
Finch T
中科院分区：
文献类型：
--
作者：
May CR;Johnson M;Finch T
环境是健康行为改变、知识转化、实践实施和健康改善研究中的一个问题。这是因为许多干预和评估设计都试图消除背景混杂因素，而这些混杂因素代表了干预措施在实践中可行时必须融入的正常条件。我们提出了一个生态模型，参与者在实施和健康改善过程中与环境互动的方式。本文解决了环境问题，因为它影响了干预措施的实施、扩大和扩散过程。我们扩展了我们早期的工作，发展了正常化过程理论，并展示了这些过程如何涉及资源动员、集体行动和谈判机制之间的相互作用。这些机制是自适应的。它们有助于复杂适应系统中的自组织。实施包括将医疗保健干预措施从封闭的评估研究系统引入“现实世界”环境的开放系统的转化工作。这些过程的结果取决于参与者和环境之间的相互作用和协商。在这些谈判中，干预成分的可塑性、参与者对资源调动和行动者贡献的自由裁量程度、以及环境的弹性都发挥着重要作用。从反馈循环、自适应机制和由此产生的实际妥协的角度来理解这些过程，使我们能够将NPT规定的机制视为复杂系统中自组织的核心要素。
Context is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice. We present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems. Implementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of ‘real world’ contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants’ discretion over resource mobilisation and actors’ contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
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3.8
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DOI：
10.1186/s13012-014-0090-3
发表时间：
2014-08-12
期刊：
Implementation science : IS
影响因子：
--
作者：
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通讯作者：
Eng JJ
DOI：
10.1186/1748-5908-8-117
发表时间：
2013-10-02
期刊：
Implementation science : IS
影响因子：
--
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通讯作者：
Stange KC