What work has to be done to implement collaborative care for depression? Process evaluation of a trial utilizing the Normalization Process Model
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BACKGROUND: There is a considerable evidence base for 'collaborative care' as a method to improve quality of care for depression, but an acknowledged gap between efficacy and implementation. This study utilises the Normalisation Process Model (NPM) to inform the process of implementation of collaborative care in both a future full-scale trial, and the wider health economy. METHODS: Application of the NPM to qualitative data collected in both focus groups and one-to-one interviews before and after an exploratory randomised controlled trial of a collaborative model of care for depression. RESULTS: Findings are presented as they relate to the four factors of the NPM (interactional workability, relational integration, skill-set workability, and contextual integration) and a number of necessary tasks are identified. Using the model, it was possible to observe that predictions about necessary work to implement collaborative care that could be made from analysis of the pre-trial data relating to the four different factors of the NPM were indeed borne out in the post-trial data. However, additional insights were gained from the post-trial interview participants who, unlike those interviewed before the trial, had direct experience of a novel intervention. The professional freedom enjoyed by more senior mental health workers may work both for and against normalisation of collaborative care as those who wish to adopt new ways of working have the freedom to change their practice but are not obliged to do so. CONCLUSIONS: The NPM provides a useful structure for both guiding and analysing the process by which an intervention is optimized for testing in a larger scale trial or for subsequent full-scale implementation.
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- Authors
- Gask, L., Bower, P., Lovell, K., Escott, D., Archer, J., Gilbody, S., Lankshear, A. J., Simpson, A. E., & Richards, D. A.
- Affiliations
- University of Manchester (GB)
- University of York (GB)
- Cardiff University (GB)
- University of Exeter (GB)
- Corresponding author
- Gask, Linda
- ORCID
- Venue
- Implementation Science
- Published
- 2010-02-10
- Volume
- 5
- Issue
- 1
- Pages
- 15-15
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC2829490
- OpenAlex
- W2135177788
- Cited by
- 75
- References
- 27
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 8 · 2019: 3 · 2018: 9 · 2017: 5 · 2016: 4 · 2015: 2 · 2014: 8 · 2013: 8 · 2012: 7
- FWCI
- 12.53
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Figshare (submittedVersion)
- Open Research Exeter (University of Exeter) (submittedVersion, cc-by)
- Research Explorer (The University of Manchester) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- collaborative care, depression, implementation process, process evaluation, relational integration, contextual integration, mental health services, implementation barriers and facilitators, professional autonomy
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