National strategy for service user involvement in the Irish health services: a case study analysis of policy implementation

National and international health policies recognise that communities should be centrally involved in shaping primary healthcare services. Using Normalisation Process Theory (NPT) this study is designed to critically explore the levers and barriers to implementing community participation in primary healthcare as a routine way of working in the Health Service Executive (HSE). A qualitative systematic review of peer-reviewed literature using NPT was completed, as was a review of the ‘service user involvement’ academic literature in primary care following the principles of a critical interpretive synthesis. A qualitative case study methodology involving a review of documents, interviews and focus groups with key informants involved in the case of the Irish ‘Joint Community Participation in Primary Care Initiative’ was also carried out. All data were analysed using NPT constructs as the basis for thematic analysis. Findings were validated through data analysis clinics and feedback sessions with participants. Researchers and practitioners alike continue to debate models, approaches, definitions and operational challenges of community participation in primary healthcare and as a policy ideal its enactment proves problematic. For many participants community participation in primary healthcare is considered to be a new and valuable way of working. Champions were seen as integral to this work, as is the need for all stakeholders involved to have a clear, shared understanding of the aims, objectives and benefits of this way of working. The need for strong partnerships was also reiterated, with some participants identifying the benefits of established relational interactions in sustaining this type of work. This study shows that NPT, whilst a new theory, provides a generalisable framework that can be applied across contexts and potentially shape implementation journeys. Findings from this NPT analysis were further used to create a theoretically informed framework to support the implementation of community participation in primary healthcare in the HSE.