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Implementation Science
Published in: Implementation Science 1/2015

Open Access 01-12-2015 | Research

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

Authors: Leesa Hooker, Rhonda Small, Cathy Humphreys, Kelsey Hegarty, Angela Taft

Published in: Implementation Science | Issue 1/2015

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Abstract

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.
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Literature
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.CrossRefPubMedPubMedCentral
3.
Richards K. Children’s exposure to domestic violence in Australia. Trends and issues in crime and criminal justice. 2011. p. 419.
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.CrossRef
6.
Department of Education and Early Childhood Development. Maternal and Child Health Service: Practice Guidelines. 2009.
7.
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.CrossRef
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
15.
Wathen CN, MacMillan HL. Health care’s response to women exposed to partner violence. JAMA. 2012;308(7):712–3.CrossRefPubMed
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.CrossRefPubMedPubMedCentral
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.CrossRefPubMedPubMedCentral
21.
May C, Finch T. Implementing, embedding, and integrating practices: an outline of Normalization Process Theory. Sociology. 2009;43(3):535–54.CrossRef
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.CrossRef
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.PubMed
24.
Creswell JW, Plano Clark VL, Garrett AL. Methodological issues in conducting mixed methods research designs. In: Bergman M, editor. Advances in Mixed Methods Research. London: SAGE Publications Ltd; 2008. p. 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.CrossRefPubMed
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.CrossRefPubMedPubMedCentral
28.
29.
QSR International. NVivo qualitative data analysis software. 2013. Version 10.
30.
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.CrossRefPubMedPubMedCentral
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.CrossRef
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRef
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.CrossRef
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;29:1003–10.CrossRefPubMed
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.CrossRef
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.CrossRef
Metadata
Title
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
Authors
Leesa Hooker
Rhonda Small
Cathy Humphreys
Kelsey Hegarty
Angela Taft
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2015
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-015-0230-4

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