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Process evaluation for complex interventions in health services research: analysing context, text trajectories and disruptions

Overview of attention for article published in BMC Health Services Research, August 2016
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  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (91st percentile)
  • High Attention Score compared to outputs of the same age and source (85th percentile)

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35 tweeters

Citations

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7 Dimensions

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53 Mendeley
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Title
Process evaluation for complex interventions in health services research: analysing context, text trajectories and disruptions
Published in
BMC Health Services Research, August 2016
DOI 10.1186/s12913-016-1651-8
Pubmed ID
Authors

Jamie Murdoch

Abstract

Process evaluations assess the implementation and sustainability of complex healthcare interventions within clinical trials, with well-established theoretical models available for evaluating intervention delivery within specific contexts. However, there is a need to translate conceptualisations of context into analytical tools which enable the dynamic relationship between context and intervention implementation to be captured and understood. In this paper I propose an alternative approach to the design, implementation and analysis of process evaluations for complex health interventions through a consideration of trial protocols as textual documents, distributed and enacted at multiple contextual levels. As an example, I conduct retrospective analysis of a sample of field notes and transcripts collected during the ESTEEM study - a cluster randomised controlled trial of primary care telephone triage. I draw on theoretical perspectives associated with Linguistic Ethnography to examine the delivery of ESTEEM through staff orientation to different texts. In doing so I consider what can be learned from examining the flow and enactment of protocols for notions of implementation and theoretical fidelity (i.e. intervention delivered as intended and whether congruent with the intervention theory). Implementation of the triage intervention required staff to integrate essential elements of the protocol within everyday practice, seen through the adoption and use of different texts that were distributed across staff and within specific events. Staff were observed deploying texts in diverse ways (e.g. reinterpreting scripts, deviating from standard operating procedures, difficulty completing decision support software), providing numerous instances of disruption to maintaining intervention fidelity. Such observations exposed tensions between different contextual features in which the trial was implemented, offering theoretical explanations for the main trial findings. The value of following how trial protocols produce new texts is that we can observe the flow of 'the intervention as intended' across a series of events which are enacted to meet specific demands of intervention delivery. Such observations are not solely premised on identifying routines or practices of implementation, but where 'protocols as intended' breaks down. In doing so, I discuss whether it is here where we might expose the 'active ingredients' of interventions in action.

Twitter Demographics

The data shown below were collected from the profiles of 35 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 53 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 3 6%
Unknown 50 94%

Demographic breakdown

Readers by professional status Count As %
Researcher 11 21%
Student > Ph. D. Student 10 19%
Student > Master 7 13%
Professor > Associate Professor 5 9%
Unspecified 4 8%
Other 16 30%
Readers by discipline Count As %
Medicine and Dentistry 17 32%
Social Sciences 9 17%
Unspecified 8 15%
Nursing and Health Professions 8 15%
Psychology 4 8%
Other 7 13%

Attention Score in Context

This research output has an Altmetric Attention Score of 21. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 29 June 2018.
All research outputs
#788,170
of 13,630,548 outputs
Outputs from BMC Health Services Research
#275
of 4,565 outputs
Outputs of similar age
#23,170
of 262,474 outputs
Outputs of similar age from BMC Health Services Research
#1
of 7 outputs
Altmetric has tracked 13,630,548 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 94th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 4,565 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.5. This one has done particularly well, scoring higher than 93% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 262,474 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 91% of its contemporaries.
We're also able to compare this research output to 7 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them