Open Access Open Badges Study protocol

REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings (RESTORE): study protocol

Anne MacFarlane1*, Catherine O’Donnell2, Frances Mair2, Mary O’Reilly-de Brún3, Tomas de Brún3, Wolfgang Spiegel4, Maria van den Muijsenbergh5, Evelyn van Weel-Baumgarten5, Christos Lionis6, Nicola Burns2, Katja Gravenhorst7, Christine Princz4, Erik Teunissen5, Francine van den Driessen Mareeuw5, Aristoula Saridaki6, Maria Papadakaki6, Maria Vlahadi6 and Christopher Dowrick7

Author Affiliations

1 Graduate Entry Medical School, University of Limerick, Limerick, Ireland

2 General Practice and Primary Care, Centre for Population and Health Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, 1 Horselethill Road, Glasgow, Scotland, G12 9LX, UK

3 Discipline of General Practice, School of Medicine No. 1 Distillery Road, National University of Ireland, Galway, Ireland

4 Department of General Practice, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, Vienna, 1090, Austria

5 Department of Primary and Community Care, 161 ELG, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen, 6500 HB, The Netherlands

6 Faculty of Medicine, University of Crete, Heraklion, Greece

7 Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Block B, 1st Floor, 1-5 Brownlow Street, Liverpool, L69 3GL, UK

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Implementation Science 2012, 7:111  doi:10.1186/1748-5908-7-111

Published: 20 November 2012



The implementation of guidelines and training initiatives to support communication in cross-cultural primary care consultations is ad hoc across a range of international settings with negative consequences particularly for migrants. This situation reflects a well-documented translational gap between evidence and practice and is part of the wider problem of implementing guidelines and the broader range of professional educational and quality interventions in routine practice. In this paper, we describe our use of a contemporary social theory, Normalization Process Theory and participatory research methodology—Participatory Learning and Action—to investigate and support implementation of such guidelines and training initiatives in routine practice.


This is a qualitative case study, using multiple primary care sites across Europe. Purposive and maximum variation sampling approaches will be used to identify and recruit stakeholders—migrant service users, general practitioners, primary care nurses, practice managers and administrative staff, interpreters, cultural mediators, service planners, and policy makers. We are conducting a mapping exercise to identify relevant guidelines and training initiatives. We will then initiate a PLA-brokered dialogue with stakeholders around Normalization Process Theory’s four constructs—coherence, cognitive participation, collective action, and reflexive monitoring. Through this, we will enable stakeholders in each setting to select a single guideline or training initiative for implementation in their local setting. We will prospectively investigate and support the implementation journeys for the five selected interventions. Data will be generated using a Participatory Learning and Action approach to interviews and focus groups. Data analysis will follow the principles of thematic analysis, will occur in iterative cycles throughout the project and will involve participatory co-analysis with key stakeholders to enhance the authenticity and veracity of findings.


This research employs a unique combination of Normalization Process Theory and Participatory Learning and Action, which will provide a novel approach to the analysis of implementation journeys. The findings will advance knowledge in the field of implementation science because we are using and testing theoretical and methodological approaches so that we can critically appraise their scope to mediate barriers and improve the implementation processes.