A qualitative systematic review of studies using the normalization process theory to research implementation processes

Abstract

BackgroundThere is a well-recognized need for greater use of theory to address research translational gaps. Normalization Process Theory (NPT) provides a set of sociological tools to understand and explain the social processes through which new or modified practices of thinking, enacting, and organizing work are implemented, embedded, and integrated in healthcare and other organizational settings. This review of NPT offers readers the opportunity to observe how, and in what areas, a particular theoretical approach to implementation is being used. In this article we review the literature on NPT in order to understand what interventions NPT is being used to analyze, how NPT is being operationalized, and the reported benefits, if any, of using NPT.MethodsUsing a framework analysis approach, we conducted a qualitative systematic review of peer-reviewed literature using NPT. We searched 12 electronic databases and all citations linked to six key NPT development papers. Grey literature/unpublished studies were not sought. Limitations of English language, healthcare setting and year of publication 2006 to June 2012 were set.ResultsTwenty-nine articles met the inclusion criteria; in the main, NPT is being applied to qualitatively analyze a diverse range of complex interventions, many beyond its original field of e-health and telehealth. The NPT constructs have high stability across settings and, notwithstanding challenges in applying NPT in terms of managing overlaps between constructs, there is evidence that it is a beneficial heuristic device to explain and guide implementation processes.ConclusionsNPT offers a generalizable framework that can be applied across contexts with opportunities for incremental knowledge gain over time and an explicit framework for analysis, which can explain and potentially shape implementation processes. This is the first review of NPT in use and it generates an impetus for further and extended use of NPT. We recommend that in future NPT research, authors should explicate their rationale for choosing NPT as their theoretical framework and, where possible, involve multiple stakeholders including service users to enable analysis of implementation from a range of perspectives.

Predictive risk stratification model: a randomised stepped-wedge trial in primary care (PRISMATIC)

“…NPT is a conceptual framework to explain implementation of innovations in health care. 78 NPT offers four constructs to describe how innovation comes into normal practice:…”

Evaluation of a national surveillance system for mortality alerts: a mixed-methods study

“…[73][74][75] In this section, an overview of the relevant aspects of these theories is described in relation to hospital trusts (organisations) working in the English NHS (the field), considering their response to the demand placed on them from Imperial College London/Dr Foster and the CQC (external institutions) through the receipt of a mortality alert letter. We review several areas of theory that are relevant to the institutional response to mortality alerts, namely institutional theory and neo-institutional theory, [74][75][76][77][78] organisational readiness for change, [79][80][81] absorptive capacity, [82][83][84][85][86][87] normalisation process theory [88][89][90] and sense-making, [91][92][93] among others. We include areas of institutional theory that were identified a priori in the initial research protocol, but have complemented these perspectives with a review of theories that emerged as relevant during the course of interaction with case study data.…”

“…The minimum proportion of trust beds occupied was 33% in the Birmingham Women's and Children's NHS Foundation Trust, and the maximum proportion was 100%, with a median (interquartile range) of 88 (83)(84)(85)(86)(87)(88)(89)(90)(91)(92), highlighting the skewed nature of the data ( Figure 10). In the quarter when the alert occurred, trust-level acute bed occupancy rates were, on average, 2.2 percentage points higher in alerting than in non-alerting trusts (p = 0.001).…”

Hot Topics and Fronts in E-health Research: A Scientometric Analysis in CiteSpace

“…The scholars who cite the article are concerned about the role and responsibility of electronic health in the medical process, risk management, ways to engage with professions, and how to ensure the potential benefits of new technologies ( Figure 12). Mcevoy Rachel studies using the normalization process theory to research implementation process [66]. Deborah studies the role of digital technologies in selfmanagement [67].…”