Applying normalization process theory to understand implementation of a family violence screening and care model in maternal and child health nursing practice: a mixed method process evaluation of a randomised controlled trial

Implementation Science

Angela Taft³  Kelsey Hegarty²  Cathy Humphreys¹  Rhonda Small³  Leesa Hooker³ 

[1] School of Social Work, University of Melbourne, Melbourne, Australia;Department of General Practice, Primary Care Research Unit, University of Melbourne, Melbourne, Australia;Judith Lumley Centre, La Trobe University, Melbourne, Australia

关键词: Complex intervention;    Maternal and child health nursing;    Intimate partner violence;    Process evaluation;    Normalization process theory;   

Others  :  1146058
DOI  :  10.1186/s13012-015-0230-4

 received in 2014-11-25, accepted in 2015-03-09,  发布年份 2015

【 摘 要 】

Background

In Victoria, Australia, Maternal and Child Health (MCH) services deliver primary health care to families with children 0–6 years, focusing on health promotion, parenting support and early intervention. Family violence (FV) has been identified as a major public health concern, with increased prevalence in the child-bearing years. Victorian Government policy recommends routine FV screening of all women attending MCH services. Using Normalization Process Theory (NPT), we aimed to understand the barriers and facilitators of implementing an enhanced screening model into MCH nurse clinical practice.

Methods

NPT informed the process evaluation of a pragmatic, cluster randomised controlled trial in eight MCH nurse teams in metropolitan Melbourne, Victoria, Australia. Using mixed methods (surveys and interviews), we explored the views of MCH nurses, MCH nurse team leaders, FV liaison workers and FV managers on implementation of the model. Quantitative data were analysed by comparing proportionate group differences and change within trial arm over time between interim and impact nurse surveys. Qualitative data were inductively coded, thematically analysed and mapped to NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring) to enhance our understanding of the outcome evaluation.

Results

MCH nurse participation rates for interim and impact surveys were 79% (127/160) and 71% (114/160), respectively. Twenty-three key stakeholder interviews were completed. FV screening work was meaningful and valued by participants; however, the implementation coincided with a significant (government directed) change in clinical practice which impacted on full engagement with the model (coherence and cognitive participation). The use of MCH nurse-designed FV screening/management tools in focussed women’s health consultations and links with FV services enhanced the participants’ work (collective action). Monitoring of FV work (reflexive monitoring) was limited.

Conclusions

The use of theory-based process evaluation helped identify both what inhibited and enhanced intervention effectiveness. Successful implementation of an enhanced FV screening model for MCH nurses occurred in the context of focussed women’s health consultations, with the use of a maternal health and wellbeing checklist and greater collaboration with FV services. Improving links with these services and the ongoing appraisal of nurse work would overcome the barriers identified in this study.

【 授权许可】

   
2015 Hooker et al.; licensee BioMed Central.

【 参考文献 】

• [1]World Health Organization: Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non partner sexual violence. 2013.
• [2]Vos T, Astbury J, Piers LS, Magnus A, Heenan M, Stanley L, et al.: Measuring the impact of intimate partner violence on the health of women in Victoria, Australia. Bull World Health Organ 2006, 84(9):739.
• [3]Richards K: Children’s exposure to domestic violence in Australia. Trends and issues in crime and criminal justice. 2011.
• [4]Australian Bureau of Statistics. Personal Safety Survey, Australia. 2013.
• [5]Walsh D: The hidden experience of violence during pregnancy: a study of 400 pregnant Australian women. Aust J Prim Health 2008, 14(1):97-105.
• [6]Department of Education and Early Childhood Development. Maternal and Child Health Service: Practice Guidelines. 2009.
• [7]FamilyViolence: Department of Human Services, Victoria. [http://www.dhs.vic.gov.au/for-individuals/children,-families-and-young-people/family-violence].
• [8]Feder G, Ramsay J, Dunne D, Rose M, Arsene C, Norman R, et al.: How far does screening women for domestic (partner) violence in different health-care settings meet criteria for a screening programme? Systematic reviews of nine UK National Screening Committee critieria. Health Technol Assess 2009, 13(16):1-113.
• [9]Taft A, O’Doherty L, Hegarty K, Ramsay J, Davidson L, Feder G. Screening women for intimate partner violence in healthcare settings. Cochrane Database Syst Rev. 2013(4). Art. No. CD007007.
• [10]McFarlane J, Groff J, O’Brien J, Watson K: Secondary prevention of intimate partner violence: a randomized controlled trial. Nurs Res 2006, 55(1):52-61.
• [11]MacMillan HL, Wathen CN, Jamieson E, Boyle MH, Shannon HS, Ford-Gilboe M, et al.: Screening for intimate partner violence in health care settings: a randomized trial. JAMA 2009, 302(5):493-501.
• [12]Tiwari A, Leung W, Leung T, Humphreys J, Parker B, Ho P: A randomised controlled trial of empowerment training for Chinese abused pregnant women in Hong Kong. BJOG 2005, 112(9):1249-56.
• [13]World Health Organization: Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines. 2013.
• [14]Hooker L, Ward B, Verrinder G: Domestic violence screening in Maternal & Child Health nursing practice: a scoping review. Contemp Nurse 2012, 42(2):198-215.
• [15]Wathen CN, MacMillan HL: Health care’s response to women exposed to partner violence. JAMA 2012, 308(7):712-3.
• [16]Department of Education and Early Childhood Development. Maternal and Child Health Service: Program Standards. 2009.
• [17]Department of Human Services. Family Violence Risk Assessment and Risk Management Framework and Practice Guides 1–3 (version 2). 2012.
• [18]Department of Education and Early Childhood Development. Maternal and Child Health Service: Key Ages and Stages Framework. 2009.
• [19]Taft A, Small R, Hegarty KL, Watson LF, Gold L, Lumley JA: Mothers’ AdvocateS In the Community (MOSAIC)-non-professional mentor support to reduce intimate partner violence and depression in mothers: A cluster randomised trial in primary care. BMC Public Health 2011, 11(1):178. BioMed Central Full Text
• [20]Taft AJ, Small R, Humphreys C, Hegarty K, Walter R, Adams C, et al.: Enhanced maternal and child health nurse care for women experiencing intimate partner/family violence: Protocol for MOVE, a cluster randomised trial of screening and referral in primary health care. BMC Public Health 2012, 12(1):811. BioMed Central Full Text
• [21]May C, Finch T: Implementing, embedding, and integrating practices: an outline of Normalization Process Theory. Sociology 2009, 43(3):535-54.
• [22]McEvoy R, Ballini L, Maltoni S, ODonnell C, Mair F, MacFarlane A: A qualitative systematic review of studies using the normalization process theory to research implementation processes. Implementation Sci 2014, 9(1):2. BioMed Central Full Text
• [23]Grol R, Wensing M: What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust 2004, 180(6 Suppl):S57.
• [24]Creswell JW, Plano Clark VL, Garrett AL: Methodological issues in conducting mixed methods research designs. In Advances in Mixed Methods Research. Edited by Bergman M. SAGE Publications Ltd, London; 2008:66-84.
• [25]Feder G, Davies RA, Baird K, Dunne D, Eldridge S, Griffiths C, et al.: Identification and referral to improve safety (IRIS) of women experiencing domestic violence with a primary care training and support programme: A cluster randomised controlled trial. Lancet 2011, 378(9805):1788-95.
• [26]Department of Planning and Community Development. Family violence risk assessment and risk management- Identifying Family Violence: Maternal and Child Health Nurses’ Training Handbook. 2008.
• [27]Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, et al.: Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med 2010, 8(1):63. BioMed Central Full Text
• [28]SurveyMonkey. [www.surveymonkey.com].
• [29]QSR International: NVivo qualitative data analysis software. 2013.
• [30]Normalization Process Theory On-line Users’ Manual and Toolkit. [http://www.normalizationprocess.org].
• [31]May C, Finch T, Mair F, Ballini L, Dowrick C, Eccles M, et al.: Understanding the implementation of complex interventions in health care: The normalization process model. BMC Health Serv Res 2007, 7(1):148. BioMed Central Full Text
• [32]Gunn JM, Palmer VJ, Dowrick CF, Herrman HE, Griffiths FE, Kokanovic R, et al.: Embedding effective depression care: using theory for primary care organisational and systems change. Implementation Sci 2010, 5:62. BioMed Central Full Text
• [33]MacMillan H, Wathen C, Jamieson E, Boyle M, McNutt L, Worster A, et al.: Approaches to screening for intimate partner violence in health care settings. JAMA 2006, 296(5):530-6.
• [34]Ploeg J, Davies B, Edwards N, Gifford W, Miller PE: Factors influencing best-practice guideline implementation: lessons learned from administrators, nursing staff, and project leaders. Worldviews Evid Based Nurs 2007, 4(4):210-9.
• [35]May C, Sibley A, Hunt K: The nursing work of hospital-based clinical practice guideline implementation: an explanatory systematic review using Normalisation Process Theory. Int J Nurs Stud 2014, 51(2):289-99.
• [36]Frasier PY, Slatt L, Kowlowitz V, Glowa PT: Using the stages of change model to counsel victims of intimate partner violence. Patient Educ Couns 2001, 43(2):211-7.
• [37]Gerbert B, Abercrombie P, Caspers N, Love C, Bronstone A: How health care providers help battered women: the survivor’s perspective. Women Health 1999, 29(3):115-35.
• [38]Hopwood N, Fowler C, Lee A, Rossiter C, Bigsby M: Understanding partnership practice in child and family nursing through the concept of practice architectures. Nursinq Inquiry 2013, 20(3):199-210.
• [39]Kruske S, Barclay L, Schmied V: Primary health care, partnership and polemic: child and family health nursing support in early parenting. Aust J Prim Health 2006, 12(2):57-65.
• [40]Baird K, Salmon D, White P: A five year follow-up study of the Bristol pregnancy domestic violence programme to promote routine enquiry. Midwifery 2013, 29:1003-1010.
• [41]Goicolea I, Vives-Cases C, San Sebastian M, Marchal B, Kegels G, Hurtig A-K: How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol. Implementation Sci 2013, 8(1):36. BioMed Central Full Text
• [42]Franx G, Oud M, De Lange J, Wensing M, Grol R: Implementing a stepped-care approach in primary care: results of a qualitative study. Implementation Sci 2012, 7:8. BioMed Central Full Text