Table 1 Summary of results
NPT core mechanism | Further description | Findings |
|---|---|---|
Coherence/sensemaking | How PHIMS is understood; how it is differentiated from previous ways to do the same thing; how the work is specified; how the meaning is internalised. | • PHIMS appears to authorise and legitimise practice because it scales up two evidence-based programmes • Practitioners give clear “before-and-after” accounts, i.e PHIMS was a large-scale transformative event • There is a spectrum of PHIMS use. At one end some are using it only to comply with mandatory reporting of the extent to which sites are achieving the designated practices (e.g. food policy at school). While at the other end PHIMS is used to structure and direct how they do their practice (e.g. following PHIMS prompts to encourage food policy at schools) |
Cognitive participation | How practitioners become engaged and take part in PHIMS work. How PHIMS work is legitimated; how practitioners are recruited/enrolled as PHIMS users and how involvement is sustained over time. | • Technical or training barriers can be associated with a lack of engagement in PHIMS. • Practitioner experience of PHIMS may be influenced by higher level (HCI and local district) management style and attitudes. • PHIMS champions incorporate a personalised one-to-one approach in training others • Missed opportunities for legitimation: some practitioners say they would be more engaged in PHIMS if they could see and understand how the central administrators benefited from their data. |
Collective action | How people come together (interact) to make the PHIMs work; organisation, structure and workability | • Time taken and technical skills in using PHIMS have become part of health promotion practice • New roles related to PHIMS use have been created and maintained within teams (e.g. data entry). • Defining minimum standard for what should be entered into PHIMS also acts to define practice. • In some sites, it’s one person’s job to enter data into PHIMS on behalf of others (the non-users). • Use of PHIMS data for team-level planning has changed the course of practice in some teams. • The colloquial language of “PHIMS guru” illustrates a form of everyday informal integration. |
Reflexive monitoring | How PHIMS is appraised; opportunities to view its benefits/costs | • The percentage of sites reaching recommended practice targets can be calculated for each team • Many practitioners appreciate the significance of health promotion across the state being made more visible through PHIMS. More could be made of this. • PHIMS makes it possible to gain instant feedback about how some forms of progress are made, allowing tailoring, coordination and adjustment of work • Criticism of what PHIMS represents (“mechanisation” or over-standardisation of health promotion) serves to articulate practice values i.e. what health promotion should be (and what PHIMS is not). Some practitioners devise ways to do what is required for reporting in PHIMS without compromising what they feel is the best way to work |