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Process evaluations of complex healthcare interventions

Franklin-Wilkins Building, Waterloo Campus, London

22 May NEV-main-WaterlooCampusFranklinWilkins

Process evaluation is the study of the delivery and functioning of an intervention, typically examining the relationship between implementation, mechanisms of impact (how the intervention works), context and outcomes. Well-established theoretical models and methods are available for conducting such investigations, highlighting the importance of accounting for dynamic context-intervention-outcome interactions. However, there is a need to translate conceptualisations of context into analytical tools that enable this dynamic relationship to be captured and understood. 

In this seminar, Dr Jamie Murdoch will discuss a novel approach to the investigation of intervention delivery within context, focusing on the conceptualisation of healthcare interventions as events that disrupt complex systems. 

As an example, he will share data from PACK Child, a pilot study of a paediatric primary care intervention delivered in South Africa. 

Using observational field notes, audio recordings and transcriptions of nurse-patient consultations, he will discuss the implementation of the PACK Child guide, a set of clinical guidelines used by nurses when consulting caregivers and children. A key focus was how the existing primary health care system impacted on nurses’ use of the guide in order to identify how to optimise implementation of the intervention on a wider scale. By analysing nurse-guide-caregiver interactional sequences within consultations, we were able to locate when and how different contextual features aligned or conflicted with one another, providing evidence of disruptions to delivery which empirically exposed the health system-intervention relationship. In doing so, this analysis enabled us to generate hypothetical propositions for resolving disruptions, which would facilitate use of the PACK Child guide to more effectively address children’s needs, and for wide-scale implementation of the intervention across South Africa and beyond.


Jamie works as a Research Fellow in Process Evaluation Methodology at the School of Health Sciences and Norwich Medical School at the University of East Anglia. 

He is Process Evaluation Lead for the Norwich Clinical Trials Unit and oversees process evaluation design across a range of health service research projects, using qualitative and mixed methods to conduct such investigations. 

He also works closely with the Knowledge Translation Unit at Cape Town University, overseeing the process evaluation of two complex healthcare interventions;

1) PACK Child - a paediatric primary care guideline and systems strengthening intervention; and 
2) ASSET - a study of person-centred TB care for providers, patients and households in South Africa. 

Jamie has a particular interest in how to study the contexts in which healthcare interventions are delivered, and in particular, the contribution of linguistic ethnographic methods to conduct such investigations.

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