Changing policy and practice: Making sense of national guidelines for osteoarthritis

Ong, Bie Nio, Morden, Andrew, Brooks, Lauren, Porcheret, Mark, Edwards, John J., Sanders, Tom, Jinks, Clare and Dziedzic, Krysia (2014) Changing policy and practice: Making sense of national guidelines for osteoarthritis. Social Science & Medicine, 106. pp. 101-109. ISSN 0277-9536

Text (Full text)
Ong et al - Changing policy and practice OA.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (639kB) | Preview
Official URL:


Understanding uptake of complex interventions is an increasingly prominent area of research. The interplay of macro (such as changing health policy), meso (re-organisation of professional work) and micro (rationalisation of clinical care) factors upon uptake of complex interventions has rarely been explored. This study focuses on how English General Practitioners and practice nurses make sense of a complex intervention for the management of osteoarthritis, using the macro–meso–micro contextual approach and Normalisation Process Theory (NPT), specifically the construct of coherence. It is embedded in a cluster RCT comprising four control practices and four intervention practices. In order to study sense-making by professionals introduction and planning meetings (N = 14) between researchers and the practices were observed. Three group interviews were carried out with 10 GPs and 5 practice nurses after they had received training in the intervention. Transcripts were thematically analysed before comparison with NPT constructs. We found that: first, most GPs and all nurses distinguished the intervention from current ways of working. Second, from the introduction meeting to the completion of the training the purpose of the intervention increased in clarity. Third, GPs varied in their understanding of their remit, while the practice nurses felt that the intervention builds on their holistic care approach. Fourth, the intervention was valued by practice nurses as it strengthened their expert status. GPs saw its value as work substitution, but felt that a positive conceptualisation of OA enhanced the consultation. When introducing new interventions in healthcare settings the interaction between macro, meso and micro factors, as well as the means of engaging new clinical practices and their sense-making by clinicians needs to be considered.

Item Type: Article
Uncontrolled Keywords: Complex interventions; Primary care; Osteoarthritis; Clinical guidelines; Normalisation Process Theory; Sense-making; England
Subjects: B900 Others in Subjects allied to Medicine
L300 Sociology
Department: Faculties > Health and Life Sciences > Social Work, Education and Community Wellbeing
Depositing User: Paul Burns
Date Deposited: 24 Jan 2019 12:56
Last Modified: 01 Aug 2021 07:35

Actions (login required)

View Item View Item


Downloads per month over past year

View more statistics