Normalisation process theory: a framework for developing, evaluating and implementing complex interventions

Murray, Elizabeth; Treweek, Shaun; Pope, Catherine; MacFarlane, Anne; Ballini, Luciana; Dowrick, Christopher; Finch, Tracy; Kennedy, Anne; Mair, Frances S; O’Donnell, Catherine; Ong, Bie Nio; Rapley, Tim; Rogers, Anne; May, Carl

doi:10.1186/1741-7015-8-63

Cited by 932 publications

(964 citation statements)

References 32 publications

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“…In addition Normalisation Process Theory (NPT) now forms a critical framework for us to understand how to implement a complex intervention such as Bridges self-management support into everyday clinical practice, so that it becomes 'normalised' Murray et al, 2010). Within the framework, implementation is defined as a complex and emergent social process, in which healthcare professionals collectively produce and embed new practices into their everyday work .…”

Section: Telling the Whole Story Beyond Efficacy Testingmentioning

confidence: 99%

Building Bridges between healthcare professionals, patients and families: A coproduced and integrated approach to self-management support in stroke

Jones

Pöstges

Brimicombe

2016

NRE

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Abstract. BACKGROUND:Programmes providing self-management support for patients and families are gaining attention and have shown promising outcomes with regards to reducing long-term unmet needs post stroke. However, notions of what good selfmanagement support looks like can differ depending on professional opinion, individual preferences, skills and experiences of patients and their families as well as on how care and rehabilitation is organised in a particular healthcare setting. This resonates with the perspective of patient-centred care, according to which the meaning of good care is not universal, but rather jointly shaped between healthcare professionals and patients in everyday interactions. While self-management support is continuously co-produced in care and rehabilitation practices, most self-management programmes are typically provided as an 'add-on' to existing statutory care. OBJECTIVE: This paper aims to deepen the understanding of how self-management support can be made an integral part of everyday care and rehabilitation using Bridges methodology. METHODS:The authors provide a self-reflective account on 'Bridges' an integrated approach to self-management support, which is used by healthcare professionals within acute and community stroke rehabilitation across the UK, and in some parts of New Zealand and Australia. RESULTS: Bridges is based on self-efficacy principles, but has a central aim of professionals sharing decision-making and expertise with patients and families in every healthcare interaction. Methodologically, the co-production of a Bridges support package with local healthcare professionals and patients is critical. The authors present the values articulated by the support package and how it engages professionals, patients and Bridges training facilitators in a continuous process of adjusting and re-adjusting situated self-management support practices. CONCLUSIONS: Our reflections reveal the need to consider development and implementation of self-management support as one and the same on-going process, if we are to facilitate successful engagement and interest from healthcare professionals as well as their patients and families.

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Section: Telling the Whole Story Beyond Efficacy Testingmentioning

confidence: 99%

Building Bridges between healthcare professionals, patients and families: A coproduced and integrated approach to self-management support in stroke

Jones

Pöstges

Brimicombe

2016

NRE

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“…Another useful contribution of Normalisation Process Theory (previously highlighted in the Introduction section) is the explicit attention to how trial parameters can be optimised, thus assisting in the design of robust, feasible and meaningful randomised controlled trials [23]. As previously described in the Introduction, this initial study was carried out prior to three linked trials, evaluating the use of different visualisation tools with people with stroke within three different contexts.…”

Section: " the Main Features Of The Tool Are That (It) Is Proven To Bmentioning

confidence: 99%

“…Table 2 identifies and defines the four core constructs through which normalisation (or the routine embedding of a practice) occurs [22]. Murray et al (2010) [23] propose that the perspectives of health care service providers about complex health interventions and practices are an important determinant of their successful implementation within routine health care. We therefore wanted to explore the potential utility of NPT in understanding the possible challenges and facilitators to the routine use of the novel technology used within this study, as suggested in discussion about wider practices of rehabilitation professionals.…”

Section: Insert Table 1 About Herementioning

confidence: 99%

Rehabilitation professionals’ perceptions of the use of new visualisation software tools with people with stroke

Ballinger

Taylor

Loudon

et al. 2016

Disability and Rehabilitation: Assistive Technology

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Purpose -The envisage programme of research was funded to explore and evaluate the use of visualisation software tools using biomechanical data within rehabilitation. Three work packages were developed to evaluate the impact of the tools within stroke rehabilitation. The research presented here aimed to explore the perceptions of rehabilitation therapists about the use of the visualisation software tools in the context of future randomised controlled trials and stroke rehabilitation practice.Methods -Sixteen therapists working in a range of stroke rehabilitation contexts participated in semi-structured interviews. Interview questions explored their current practice, and the perceived impact of the new visualisation technologies on their workplace environment and practice. Framework analysis was used to analyse the textual data.Results -In general the stroke therapists were enthusiastic about the potential application of the visualisation software tools. Three themes were identified through qualitative framework analysis: potential uses of the visualisation tools; integration within current service provision; and trial involvement. Conclusions -The study highlights important contextual considerations which may impact significantly on the success of novel technologies in stroke rehabilitation.Normalisation process theory was proposed as a useful process evaluation methodology to optimise both trial evaluation and future service implementation.

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“…398 At the other end we might have a relatively finished and concrete example, such as a new prescription medicine, for which the uses and market niche are well defined and the prescriber can trial the product with relatively little disruption to everyday practice. Towards the centre of the continuum we might find instances such as telecare or educational packages that have more profound implications for changes in existing roles and workload, but which are nevertheless discrete and relatively specific.…”

Section: Understanding the Amp Modelmentioning

confidence: 99%

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Dowrick

Chew‐Graham

Lovell

et al. 2013

Programme Grants for Applied Research

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BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Normalisation process theory: a framework for developing, evaluating and implementing complex interventions

Cited by 932 publications

References 32 publications

Building Bridges between healthcare professionals, patients and families: A coproduced and integrated approach to self-management support in stroke

Building Bridges between healthcare professionals, patients and families: A coproduced and integrated approach to self-management support in stroke

Rehabilitation professionals’ perceptions of the use of new visualisation software tools with people with stroke

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

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