Health professionals’ and patients’ reactions to the implementation of healthy heart checks: an application of Normalisation Process Theory

Background and Context This ‘speed dating’ paper will report on the initial design of my PhD work. In 2008 the Department of Health launched NHS Health Checks, a nationwide programme to assess risk factors for cardiovascular disease in people aged 40 to 74. The local response was the development of the Tees Vascular Assessment Programme which offered patients ‘Healthy Heart Checks’ (HHC) in GP practices, some community pharmacies and workplaces. The aim of my PhD is to explore the implementation of HHCs in GP settings and patient responses to the programme. The study will employ Normalisation Process Theory (NPT) as a tool to frame the research (May et al, 2009). Approach to Knowledge Exchange NPT (May et al, 2009) offers a mid level theoretical framework for exploring decision making processes and the ‘normalisation of new practices within both the ‘closed’ system of GP practices and the ‘open’ system of individual patient responses. The process of ‘normalising’ new practices can be linked to the process of translation of knowledge or evidence into practice. Assessing the Impact GP teams have been delivering HHCs for over a year yet there is great variability in the way it is delivered and in the success GP teams are having identifying those to be at high risk (Oswald et al, 2010). Therefore, it is proposed to select two case study sites to explore how the GP teams make sense of the programme, actively deliver the HHCs and monitor its worth and progress. Likewise, patients who have been identified as being high risk are currently being recalled by their GP for the first annual review – a process to check patient fidelity to their programme of care. Patient adherence to the programme is essential to its success. A sample of patients attending their annual review will be interviewed to investigate their compliance to the HHC programme and the impact it has had on their lives. Data from the case studies and interviews will be analysed using an NPT framework to provide insight into the construction of the HHC programme from GP practice and patients’ point of view. Lessons and Messages This study will inform future rollout of the HHC programme and contribute to the understanding of how new evidence and practices are incorporated into health systems and individual health behaviours.