Ethnographic process evaluation in primary care: explaining the complexity of implementation.
Ethnographic process evaluation in primary care: explaining the complexity of implementation.
复制标题
DOI：
10.1186/s12913-014-0607-0
复制
发表时间：
2014-12-05
影响因子：
2.8
通讯作者：
Nelson C
中科院分区：
文献类型：
--
作者：
Bunce AE;Gold R;Davis JV;McMullen CK;Jaworski V;Mercer M;Nelson C
最近在护理提供系统中实施研究的增长导致了对方法学方法的新兴趣，这些方法学方法不仅提供干预结果数据，而且还提供对实施过程中复杂动态的深刻理解。我们建议采用人种学方法进行过程评估，并与定量数据相结合，可以为干预结果提供这种细微的见解。在这种民族志过程评价中使用的具体方法很少被详细介绍；我们的目标是激发围绕卫生保健环境中特定数据收集方法的成功和挑战的对话。我们以俄勒冈州波特兰的11个社区诊所为例，进行了一项转化临床试验，这些诊所正在实施以证据为基础的健康信息技术（HIT）干预，重点关注糖尿病患者。我们的民族志过程评估采用了临床研究员工的每周日记、观察、非正式和正式访谈、文件审查、调查和小组讨论，以确定实施成功的障碍和促进因素，提供对定量研究结果的见解，并揭示可能可转移到其他实施项目的经验教训。这些方法从深度和广度上抓住了有助于采取干预措施的因素，同时最大限度地减少了对临床工作的干扰，并支持实施战略的中游转变。一个主要的挑战是需要投入大量的研究时间。通过民族志方法可以获得干预结果背后的“如何”和“为什么”的深刻理解，提高了研究结果的可信度和可转移性。我们鼓励其他国家在实施评估和卫生服务研究方面分享其在人种学方面的经验，并考虑将本文所述的方法和工具用于其自己的研究。本文的在线版本（doi:10.1186/s12913-014-0607-0）包含补充材料，可供授权用户使用。
The recent growth of implementation research in care delivery systems has led to a renewed interest in methodological approaches that deliver not only intervention outcome data but also deep understanding of the complex dynamics underlying the implementation process. We suggest that an ethnographic approach to process evaluation, when informed by and integrated with quantitative data, can provide this nuanced insight into intervention outcomes. The specific methods used in such ethnographic process evaluations are rarely presented in detail; our objective is to stimulate a conversation around the successes and challenges of specific data collection methods in health care settings. We use the example of a translational clinical trial among 11 community clinics in Portland, OR that are implementing an evidence-based, health-information technology (HIT)-based intervention focused on patients with diabetes. Our ethnographic process evaluation employed weekly diaries by clinic-based study employees, observation, informal and formal interviews, document review, surveys, and group discussions to identify barriers and facilitators to implementation success, provide insight into the quantitative study outcomes, and uncover lessons potentially transferable to other implementation projects. These methods captured the depth and breadth of factors contributing to intervention uptake, while minimizing disruption to clinic work and supporting mid-stream shifts in implementation strategies. A major challenge is the amount of dedicated researcher time required. The deep understanding of the ‘how’ and ‘why’ behind intervention outcomes that can be gained through an ethnographic approach improves the credibility and transferability of study findings. We encourage others to share their own experiences with ethnography in implementation evaluation and health services research, and to consider adapting the methods and tools described here for their own research. The online version of this article (doi:10.1186/s12913-014-0607-0) contains supplementary material, which is available to authorized users.
登录
查看更多内容
影响因子：
1.7
作者：
McMullen CK;Ash JS;Sittig DF;Bunce A;Guappone K;Dykstra R;Carpenter J;Richardson J;Wright A
通讯作者：
Wright A
影响因子：
0.7
作者：
Butler, Mary
通讯作者：
Butler, Mary
影响因子：
6.6
作者：
Greenhalgh, Trisha;Russell, Jill;Parsons, Wayne
通讯作者：
Parsons, Wayne
影响因子：
1.7
作者：
Guest, Greg;Bunce, Arwen;Johnson, Laura
通讯作者：
Johnson, Laura
影响因子：
1.7
作者：
Cohen, Deborah J.;Leviton, Laura C.;Crabtree, Benjamin F.
通讯作者：
Crabtree, Benjamin F.