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Fam Pract. 2015 Aug;32(4):420-5. doi: 10.1093/fampra/cmv022. Epub 2015 Apr 27.

Guidelines and training initiatives that support communication in cross-cultural primary-care settings: appraising their implementability using Normalization Process Theory.

Author information

Discipline of General Practice, National University of Ireland, Galway, Ireland,
Discipline of General Practice, National University of Ireland, Galway, Ireland.
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands, Australian National University, Canberra, Australia.
University of Liverpool, Liverpool, UK.
Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Department of General Practice and Family Medicine, Medical University of Vienna, Vienna, Austria and.
Graduate Entry Medical School, University of Limerick, Limerick, Ireland.



Guidelines and training initiatives (G/TIs) available to support communication in cross-cultural primary health care consultations are not routinely used. We need to understand more about levers and barriers to their implementation and identify G/TIs likely to be successfully implemented in practice.


To report a mapping process used to identify G/TIs and to prospectively appraise their implementability, using Normalization Process Theory (NPT).


RESTORE is a 4-year EU FP-7 project. We used purposeful and network sampling to identify experts in statutory and non-statutory agencies across Austria, England, Greece, Ireland, Scotland and the Netherlands who recommended G/TI data from the grey literature. In addition, a peer review of literature was conducted in each country. Resulting data were collated using a standardized Protocol Mapping Document. G/TIs were identified for inclusion by (i) initial elimination of incomplete G/TI material; (ii) application of filtering criteria; and (iii) application of NPT.


20 G/TIs met selection criteria: 8 guidelines and 12 training initiatives. Most G/TIs were identified in the Netherlands (n = 7), followed by Ireland (n = 6) and England (n = 5). Fewer were identified in Scotland (n = 2), and none in Greece or Austria. The majority (n = 13) were generated without the inclusion of migrant service users. All 20 were prospectively appraised for potential implementability by applying NPT.


NPT is useful as a means of prospectively testing G/TIs for implementability. Results indicate a need to initiate meaningful engagement of migrants in the development of G/TIs. A European-based professional standard for development and assessment of cross-cultural communication resources is advised.


Community involvement; Normalization Process Theory; migrant health; primary care.

[Indexed for MEDLINE]

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