Evaluating Implementation Contexts, Mechanisms, and Outcomes: A Normalization Process Theory Coding Manual for Qualitative Research and Instrument Development

Abstract

Background. Qualitative studies, especially those conducted by teams of researchers, may benefit from clearly structured, parsimonious, coding manuals. The process of creating rigorous and robust coding manuals for individual studies is rarely described, and generalizable coding manuals are rare. Normalization Process Theory (NPT) provides conceptual tools to facilitate understanding of the dynamics of adoption, implementation, and sustainment of socio-technical and organizational innovations. As a widely used theory, a generalizable coding manual would be of utility to implementation researchersObjectives. To make the application of NPT simple for the user, to describe the development of a coding manual for qualitative content analytic studies using NPT, and present this for wider use.Method. Concept Selection and Structuring. Qualitative Content Analysis of selected published papers and interview transcripts. Results. All identifiable theoretical concepts (n=149) embedded in papers and chapters that developed NPT between 2006 and 2020 were identified and extracted from their texts. Overlapping, ambiguous, and duplicate versions of concepts were eliminated, as were concepts derived from other theories. This left 38 core concept definitions. These were piloted in coding of qualitative transcripts collected in two implementation studies, and by collaboratively coding papers collected for a systematic review of implementation studies. At the end of this process, a further process of elimination of overlapping or ambiguous concepts was undertaken leaving 12 primary NPT concepts. Conclusion. The process of coding manual resulted in the presentation of NPT concepts according to the Context-Mechanism-Outcomes configuration of realist evaluation research. A coding manual for NPT that is in accordance with realistic evaluation research was successfully produced and is now freely available to researchers who wish to use NPT in primary and secondary research that employs qualitative methods.

Family, nurse, and physician beliefs on family‐centered rounds: A 21‐site study

“…Addressing attitudinal barriers can be complex. Normalization process theory is a sociological theory in which individuals must assign meaning to an action (sensemaking), commit, expend effort, and assess the value of an action before complex behaviors become routine practice 31 . This theory suggests that gaps between resident‐physician beliefs and other stakeholder beliefs may be narrowed by ensuring resident physicians understand and accept the benefits of nurse and family engagement (i.e., sensemaking).…”

“…Normalization process theory is a sociological theory in which individuals must assign meaning to an action (sensemaking), commit, expend effort, and assess the value of an action before complex behaviors become routine practice. 31 This theory suggests that gaps between resident-physician beliefs and other stakeholder beliefs may be narrowed by ensuring resident physicians understand and accept the benefits of nurse and family engagement (i.e., sensemaking). Promoted at the organizational and team level, sensemaking may help narrow the belief gaps demonstrated by team members to incorporate nurse and family input during FCR; however basic workflow needs must first and foremost be T A B L E 1 Resident physician, attending physician, and nurse beliefs regarding the importance of family participation on rounds understood.…”

Using Normalisation Process Theory in general practice research

“…The Normalization MeAsure Development (NoMAD) tool asks participants to rate their agreement with different statements on a five-point Likert scale. 8 The 23 survey questions relate to the different categories of the NPT framework, and this allows for quantification of participants' perspectives on how well things are working in relation to the parts of the NPT framework. The NoMAD survey can be repeated over time to track changes in the normalisation process.…”

A Complex Intervention for Alcohol Misuse Among Conflict-Affected Populations in Uganda and Ukraine: Study Protocol for the Qualitative Components in the CHANGE Trial

“…Understanding implementation as a temporal process: Qualitative sub-studies in Phases 1–3 will produce information about factors that promote or inhibit the implementation of PM+A. Interview transcripts and data summaries collected in sub-studies through the life of CHANGE will be explored using a prescheduled theoretical framework (May et al, under review) drawing on Normalization Process Theory (May & Finch, 2009) to perform comparative qualitative content analysis of implementation processes within and between sites (Hsieh & Shannon, 2005). These analyses will contribute to our understanding of the mechanisms that shape implementation of PM+A in practice.8.…”