Cited by 770Health Policy Implementation ScienceClinical practice guidelines implementationEvaluation and Performance Assessment

The DOI matches its Crossref record; 26 of the 26 references it cites were found in a registry or an index.

Understanding the implementation of complex interventions in health care: the normalization process model

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Abstract

Background: The Normalization Process Model is a theoretical model that assists in explaining the processes by which complex interventions become routinely embedded in health care practice. It offers a framework for process evaluation and also for comparative studies of complex interventions. It focuses on the factors that promote or inhibit the routine embedding of complex interventions in health care practice. Methods: A formal theory structure is used to define the model, and its internal causal relations and mechanisms. The model is broken down to show that it is consistent and adequate in generating accurate description, systematic explanation, and the production of rational knowledge claims about the workability and integration of complex interventions. Results: The model explains the normalization of complex interventions by reference to four factors demonstrated to promote or inhibit the operationalization and embedding of complex interventions (interactional workability, relational integration, skill-set workability, and contextual integration). Conclusion: The model is consistent and adequate. Repeated calls for theoretically sound process evaluations in randomized controlled trials of complex interventions, and policy-makers who call for a proper understanding of implementation processes, emphasize the value of conceptual tools like the Normalization Process Model.

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Crossref · 10.1186/1472-6963-7-148

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Show all 25 references

Research works printed but not linked: 4

  1. MRC: A framework for development and evaluation of complex interventions to improve health. 2000, London: Medical Research Council
  2. Rogers EM: The diffusion of innovation. 1995, New York: Free Press, 4
  3. Hechter M, Horne C: Theory is explanation. Theories of social order. Edited by: Hechter M, Horne C. 2003, Stanford CA: Stanford University Press
  4. Kennedy A, Gately C, Rogers A: National evaluation of the expert patient programme: assessing the process of embedding the EPP in the NHS. 2003, Manchester: NPCRDC

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Metadata

Authors
May, C., Finch, T., Mair, F., Ballini, L., Dowrick, C., Eccles, M., Gask, L., MacFarlane, A., Murray, E., Rapley, T., Rogers, A., Treweek, S., Wallace, P., Anderson, G., Burns, J., & Heaven, B.
Affiliations
  • Newcastle University (GB)
  • University of Glasgow (GB)
  • Agenzia Sanitaria e Sociale Regionale (IT)
  • University of Liverpool (GB)
  • University of Manchester (GB)
  • Ollscoil na Gaillimhe – University of Galway (IE)
  • The Royal Free Hospital (GB)
  • University of Dundee (GB)
Corresponding author
May, Carl
Venue
BMC Health Services Research
Published
2007-09-19
Volume
7
Issue
1
Pages
148-148
ISSN
1472-6963 (ISSN-L)
OpenAlex
W2122402281
Cited by
768
References
25
Citations by year
2026: 20 · 2025: 43 · 2024: 67 · 2023: 53 · 2022: 57 · 2021: 67 · 2020: 107 · 2019: 39 · 2018: 41 · 2017: 41 · 2016: 40 · 2015: 35 · 2014: 38 · 2013: 25 · 2012: 28
FWCI
23.04
Type
journal article
Language
en
Open access
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • Northumbria Research Link (Northumbria University) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • BIBSYS Brage (BIBSYS (Norway)) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • Newcastle University ePrints (Newcastle Univesity)
Funders
  • National Institute for Health and Care Research
  • European Commission
  • Economic and Social Research Council
  • Health Technology Assessment Programme
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Social Sciences › Public Administration › Evaluation and Performance Assessment
Keywords
complex interventions, intervention implementation, process evaluation, relational integration, contextual integration, health care practices, causal mechanisms
MeSH terms
Humans, Models, Theoretical, Practice Patterns, Physicians', Randomized Controlled Trials as Topic, Evidence-Based Medicine, Guideline Adherence

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