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Cited by 1,409Health Policy Implementation ScienceQualitative Research Methods and ApplicationsInformation Systems Theories and Implementation

Development of a theory of implementation and integration: Normalization Process Theory

Open access
May, Carl R, Mair, Frances, Finch, Tracy, MacFarlane, Anne, Dowrick, Christopher, Treweek, Shaun, Rapley, Tim, Ballini, Luciana +7 more·2009·Implementation Science
DOI 10.1186/1748-5908-4-29PMC PMC2693517
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Abstract

BACKGROUND: Theories are important tools in the social and natural sciences. The methods by which they are derived are rarely described and discussed. Normalization Process Theory explains how new technologies, ways of acting, and ways of working become routinely embedded in everyday practice, and has applications in the study of implementation processes. This paper describes the process by which it was built. METHODS: Between 1998 and 2008, we developed a theory. We derived a set of empirical generalizations from analysis of data collected in qualitative studies of healthcare work and organization. We developed an applied theoretical model through analysis of empirical generalizations. Finally, we built a formal theory through a process of extension and implication analysis of the applied theoretical model. RESULTS: Each phase of theory development showed that the constructs of the theory did not conflict with each other, had explanatory power, and possessed sufficient robustness for formal testing. As the theory developed, its scope expanded from a set of observed regularities in data with procedural explanations, to an applied theoretical model, to a formal middle-range theory. CONCLUSION: Normalization Process Theory has been developed through procedures that were properly sceptical and critical, and which were opened to review at each stage of development. The theory has been shown to merit formal testing.

AI snapshot

Written from the paper’s full text.

TL;DR

This paper describes how Normalization Process Theory (NPT) was developed through three phases: empirical generalizations from qualitative healthcare studies, an applied Normalization Process Model (NPM), and a formal middle-range theory. NPT explains implementation, embedding, and integration through four generative mechanisms—coherence, cognitive participation, collective action, and reflexive monitoring—and is presented as meriting formal testing.

Key findings

  • NPT was built in three phases: empirical generalizations from secondary analyses of qualitative healthcare data (2001–2004), an applied NPM (2003–2007), and a formal middle-range theory (2006–2009).
  • The NPM’s four constructs—interactional workability, relational integration, skill-set workability, and contextual integration—became the collective action component of NPT; NPT adds coherence, cognitive participation, and reflexive monitoring as generative mechanisms.
  • Road testing included applying the NPM in three large qualitative studies and coding two datasets with both NPM and NPT; the authors report that the constructs did not conflict, had explanatory power, and were stable enough for formal testing.
  • NPT is presented as a middle-range sociological theory of implementation, embedding, and integration; formal testing was not conducted in this paper, and results are said to be forthcoming.

Methods

  • Design: a theory-building account using secondary analysis of qualitative data, grounded theory-building techniques, extension and implication analysis, analytical theorizing, and “road testing.”
  • Data/sample: qualitative studies of healthcare work and organization across four domains—telemedicine normalization, professional–patient interaction and chronic illness care, and the social production and operationalization of evidence in the clinical encounter—plus later applications in e-health, telecare, a randomized controlled trial, and shared decision-making.
  • Analysis: derived empirical generalizations, built the NPM, reformulated its constructs as generic mechanisms, mapped macro–micro links, and assessed construct stability and analytic advantage by applying NPM and NPT to data and research syntheses.

Limitations

  • The paper states that it did not formally test or falsify the NPM or NPT; “road testing” only assessed whether the theory was fit to be tested, and formal test results are forthcoming.
  • The authors state that procedural accounts of theory-building risk imposing an artificial order on processes that are highly contingent, opportunistic, and organic.
  • Evident from the text: no empirical outcomes, effect sizes, or formal validation results are reported; the claims rest on conceptual coherence, face validity, and practical application rather than definitive testing.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1748-5908-4-29

Cites

61 of 61 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 73 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    The NPM synthesized empirical generalizations from groups of related studies, producing taxonomies, maps of relations between concepts, and generalizations.

    “At this stage, the NPM synthesized empirical generalizations from groups of related studies, and producing taxonomies, maps of relations between concepts, and generalizations [24].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A: Synthesising qualitative and quantitative evidence in reviews: a review of methods. J Hlth Serv Res Pol. 2005, 10: 45-53. 10.1258/1355819052801804. source

      Not checked in the free run.

  • Findingown data

    Each phase of theory development showed that the constructs of the theory possessed sufficient robustness for formal testing.

    “Each phase of theory development showed that the constructs of the theory did not conflict with each other, had explanatory power, and possessed sufficient robustness for formal testing.”
    Quote in the paperSubstantial claim
  • Findingnone given

    'Road testing' showed that the NPM had utility in explaining factors that promoted and inhibited collective action in operationalizing practices.

    “'Road testing' showed that it had utility in explaining factors that promoted and inhibited collective action in operationalizing practices.”
    Quote in the paperSubstantial claim
  • Findingnone given

    Each phase of theory development showed that the constructs of the theory did not conflict with each other.

    “Each phase of theory development showed that the constructs of the theory did not conflict with each other, had explanatory power, and possessed sufficient robustness for formal testing.”
    Quote in the paperSubstantial claim
  • Findingreasoning

    NPT extends the NPM.

    “In fact, it extends it.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 38
  • May combine two claims. 20

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    The empirical generalizations produced in phase one were general conclusions about regularities in the data, and were framed as formal propositions.

    “The empirical generalizations produced by these processes were general conclusions about regularities in the data, and were framed as formal propositions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    By the end of 2006, the NPM in its published form was sufficient as a set of conceptual tools to analyse specific processes, and it has been successfully applied to this purpose.

    “By the end of 2006, the NPM in its published form [7] was sufficient as a set of conceptual tools to analyse specific processes, and it has been successfully applied to this purpose [32-36].”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [7] May C: A rational model for assessing and evaluating complex interventions in health care. BMC Health Serv Res. 2006, 6: 86-10.1186/1472-6963-6-86. source

      Not checked in the free run.

    • cites [32] Morriss R: Implementing clinical guidelines for bipolar disorder. Psychology and Psychotherapy-Theory Research and Practice. 2008, 81: 437-458. 10.1348/147608308X278105. source

      Not checked in the free run.

    • cites [33] Gask L, Rogers A, Campbell S, Sheaff R: Beyond the limits of clinical governance: the case of mental health in primary care. BMC Health Serv Res. 2008, 8: 63-10.1186/1472-6963-8-63. source

      Not checked in the free run.

    • cites [34] King G, Richards H, Godden D: Adoption of telemedicine in Scottish remote and rural general practices: a qualitative study. J Teleme Telecare. 2007, 13 (8): 382-386. 10.1258/135763307783064430. source

      Not checked in the free run.

    • cites [35] Mair FS, Hiscock J, Beaton SC: Understanding factors that inhibit or promote the utilization of telecare in chronic lung disease. Chronic Ill. 2008, 4 (2): 110-117. 10.1177/1742395308092482. source

      Not checked in the free run.

    • cites [36] Finch TL, Mair FS, May CR: Teledermatology in the UK: lessons in service innovation. Brit J Dermatol. 2007, 156 (3): 521-527. 10.1111/j.1365-2133.2006.07608.x. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    The processes of theoretical development described in this paper were opportunistic and organic in the beginning.

    “However, we can say that the processes of theoretical development described in this paper were opportunistic and organic in the beginning.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingreasoning

    'Road testing' the NPM enabled the authors to work through these problems and provided a context in which to make rational decisions about face validity, and to ask whether the NPM merited formal testing.

    “'Road testing' the NPM enabled us to work through these problems and provided a context in which to make rational decisions about face validity, and to ask whether the NPM merited formal testing.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The NPM's constructs were linked together by sociological explanations of the relations between its constructs, their dimensions, and components.

    “These were linked together by sociological explanations of the relations between its constructs, their dimensions, and components.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Findingnone given

    The procedures led to a set of propositions that possessed sufficient face validity and conceptual robustness to warrant formal testing.

    “We show how these procedures led to a set of propositions that possessed sufficient face validity and conceptual robustness to warrant formal testing.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The extended NPM derived from this work had a general character, and the generative mechanisms and components to which it referred were not exclusive to complex interventions or even healthcare.

    “The extended NPM that was derived from this work now had a general character, and the generative mechanisms and components to which it referred were not exclusive to complex interventions or even healthcare.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The process of road testing NPT was important because it paralleled the final revisions of the NPT as subsequently accepted for publication.

    “This process was important because it paralleled the final revisions of the NPT as subsequently accepted for publication.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    NPT extends the applied theoretical model to include the ways by which actors make sense of a set of practices (coherence), the means by which they participate in them (cognitive participation), and the forms of appraisal that they apply (reflexive monitoring).

    “The NPT, however, extends the applied theoretical model to include the ways by which actors make sense of a set of practices (coherence), the means by which they participate in them (cognitive participation), and the forms of appraisal that they apply (reflexive monitoring)”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingreasoning

    The constructs of the NPM are central to the formal theory and constitute its collective action component.

    “The constructs of the NPM are central to the formal theory and constitute its collective action component.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Between 2006 and 2009, the applied theoretical model of the NPM was extended, new constructs defined, and generative mechanisms defined, so that it formed a formal middle-range theory - NPT.

    “Between 2006 and 2009, the applied theoretical model of the NPM was extended, new constructs defined, and generative mechanisms defined, so that it formed a formal middle-range theory – NPT.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The NPM did not explain how practices were formed in ways that held together, how actors were enrolled into them, or how they were appraised.

    “It did not, however, explain how practices were formed in ways that held together, how actors were enrolled into them, or how they were appraised.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The extended NPM referred to generic properties of implementation processes and offered an explanation of them without reference to specific social contexts.

    “They referred instead to generic properties of implementation processes and offered an explanation of them without reference to specific social contexts.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Taken together, the NPM set the scene for possible empirical verification.

    “Taken together these set the scene for possible empirical verification.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The road testing of the NPM was not formal testing, because the authors did not at this stage seek to falsify the NPM; instead, they practically tested its usefulness as an analytic tool.

    “It is important to be clear that this was not formal testing, because we did not at this stage seek to falsify the NPM. Instead, we practically tested its usefulness as an analytic tool.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    These reviews reflect calls for the use of theories to generate testable hypotheses linking tailored strategies with factors that promote or inhibit implementation, and attempts to identify theories or constructs best suited for successful implementation.

    “They reflect calls for the use of theories to generate testable hypotheses linking tailored strategies with factors that promote or inhibit implementation, and various attempts to identify theories or constructs within theories best suited for successful implementation [15].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14 (1): 26-33. 10.1136/qshc.2004.011155. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    NPT addresses integration as a core problem.

    “3. Integration, by which we mean the processes by which a practice or practices are reproduced and sustained among the social matrices of an organization or institution.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    NPT is a theory of action.

    “It is a theory of action.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The starting point of NPT is that to understand the embedding of a practice we must look at what people actually do and how they work.

    “The starting point of the theory is that to understand the embedding of a practice we must look at what people actually do and how they work.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    NPT addresses embedding as a core problem.

    “2. Embedding, by which we mean the processes through which a practice or practices become, (or do not become), routinely incorporated in everyday work of individuals and groups.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    NPT postulates that practices become routinely embedded - or normalized - in social contexts as the result of people working, individually and collectively, to enact them.

    “1. Practices become routinely embedded – or normalized – in social contexts as the result of people working, individually and collectively, to enact them.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    NPT postulates that the production and reproduction of a practice requires continuous investment by agents in ensembles of action that are carried forward in time and space.

    “3. The production and reproduction of a practice requires continuous investment by agents in ensembles of action that are carried forward in time and space.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    NPT addresses implementation as a core problem.

    “1. Implementation, by which we mean the social organization of bringing a practice or practices into action.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Normalization Process Theory has applications in the study of implementation processes.

    “Normalization Process Theory explains how new technologies, ways of acting, and ways of working become routinely embedded in everyday practice, and has applications in the study of implementation processes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    An important critique of theory building is that it is sometimes precipitate, proceeding before the generalizability of the phenomena it is concerned with is properly established.

    “An important critique of theory building is that it is sometimes precipitate, proceeding before the generalizability of the phenomena it is concerned with is properly established [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Goldthorpe JH: On Sociology: Critique and Program. 2006, Stanford: Stanford University Press

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A second critique is that theory-builders focus too early on the problem of defining and measuring variables supposed to be relevant, without sufficient consideration of the coherence and robustness of basic concepts and constructs of the theory itself.

    “A second critique is that theory-builders focus too early on the problem of defining and measuring variables supposed to be relevant, without sufficient consideration of the coherence and robustness of basic concepts and constructs of the theory itself [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Wacker JG: A theory of formal conceptual definitions: developing theory-building measurement instruments. J Operations Management. 2004, 22 (6): 629-650. 10.1016/j.jom.2004.08.002. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The NPM was framed as a set of analytic propositions that were supported by rigorous data analysis.

    “This was framed as a set of analytic propositions (see Appendix 2) that were supported by rigorous data analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Normalization Process Theory explains how new technologies, ways of acting, and ways of working become routinely embedded in everyday practice.

    “Normalization Process Theory explains how new technologies, ways of acting, and ways of working become routinely embedded in everyday practice, and has applications in the study of implementation processes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The empirical generalizations did not in themselves make a theory because they were specific to particular contexts and were not linked together by an account of causal relations, generative mechanisms, or organizing principles.

    “They did not in themselves make a theory because they were specific to particular contexts (i.e., although they were generalizations, they were not necessarily generalizable), and were not linked together by some account of causal relations, generative mechanisms, or organizing principles.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationnone given

    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 operationalized in healthcare and other institutional settings.

    “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 operationalized in healthcare and other institutional settings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Unless there is already a large body of literature that presents studies that have interrogated or tested a particular theory in play, we are then stuck with the problem of how to evaluate its relation to the phenomena that it seeks to explain.

    “Unless there is already a large body of literature that presents studies that have interrogated or tested a particular theory in play, we are then stuck with the problem of how to evaluate its relation to the phenomena that it seeks to explain.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisereasoning

    Although there are many papers that seek to present some new theory, we can often discover little about where they come from or about the methods by which they were derived.

    “So, although there are many papers that seek to present some new theory, we can often discover little about where they come from or about the methods by which they were derived.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The processes of theory development described in the paper have included changes in scope, as well as method.

    “The processes of theory development described here have included changes in scope, as well as method.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Premisenone given

    Such theories sometimes seem to spring fully-formed from critiques of the literature, or by assertions about prior theories.

    “Such theories sometimes seem to spring fully-formed from critiques of the literature, or by assertions about prior theories.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The goal of theory-building at the formal level is to isolate the generic properties of phenomena and understand their operation.

    “The goal of theory-building at this level is to isolate the generic properties of phenomena and understand their operation [37].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Turner JH: Analytical Theorizing. Social Theory Today. Edited by: Giddens A, Turner J. 1987, Cambridge: Polity Press, 156-194.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    'Road testing' NPT required demonstrating that these constructs could be operationalized in a way that conferred an analytic advantage.

    “We then had to demonstrate that these constructs could be operationalized in a way that conferred an analytic advantage.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The process of theory-building described in this paper has led from secondary analysis of qualitative data through to the development of a set of generic theoretical propositions that can be employed to explain implementation and integration.

    “The process of theory-building described in this paper has led from secondary analysis of qualitative data through to the development of a set of generic theoretical propositions that can be employed to explain implementation and integration.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The criteria for stability of NPT constructs were that the generic constructs could be translated into specific contexts without the addition of ad hoc conditions, and that sceptical researchers were able to use them in practice with minimal support.

    “The criteria for stability were that the generic constructs could be translated into specific contexts without the addition of ad hoc conditions, and that sceptical researchers were able to use them in practice with minimal support.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Premisenone given

    The production of a formal theory is a quite different enterprise than the work that goes into the identification of empirical generalizations or applied explanations.

    “The production of a formal theory is a quite different enterprise than the work that goes into the identification of empirical generalizations or applied explanations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The NPM is unchanged by the development of NPT, and researchers can continue to successfully use the NPM in settings where only those factors that promoted or inhibited collective action are at issue.

    “The NPM is unchanged by this, and researchers can continue to successfully use the NPM in settings where only those factors that promoted or inhibited collective action are at issue [32-35,45,46].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [32] Morriss R: Implementing clinical guidelines for bipolar disorder. Psychology and Psychotherapy-Theory Research and Practice. 2008, 81: 437-458. 10.1348/147608308X278105. source

      Not checked in the free run.

    • cites [33] Gask L, Rogers A, Campbell S, Sheaff R: Beyond the limits of clinical governance: the case of mental health in primary care. BMC Health Serv Res. 2008, 8: 63-10.1186/1472-6963-8-63. source

      Not checked in the free run.

    • cites [34] King G, Richards H, Godden D: Adoption of telemedicine in Scottish remote and rural general practices: a qualitative study. J Teleme Telecare. 2007, 13 (8): 382-386. 10.1258/135763307783064430. source

      Not checked in the free run.

    • cites [35] Mair FS, Hiscock J, Beaton SC: Understanding factors that inhibit or promote the utilization of telecare in chronic lung disease. Chronic Ill. 2008, 4 (2): 110-117. 10.1177/1742395308092482. source

      Not checked in the free run.

    • cites [45] May C, Mair FS, Dowrick C, Finch T: Process evaluation of complex interventions in primary care: understanding trials using the normalization process model. BMC Fam Pract. 2007, 8: 42-10.1186/1471-2296-8-42. source

      Not checked in the free run.

    • cites [46] Wilkes S: Evaluation of open access hysterosalpingography in the initial management of infertility in primary care. 2007, Unpublished PhD Thesis, University of Sunderland

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The development of explanatory ideas around normalization has shifted from an initial set of empirical generalizations presented as synthetic propositions or assertions [17], to a robust conceptual model that presented generalizable propositions [7], and finally to a middle-range theory that offers a set of mechanism-based explanations for processes of implementation, embedding, and integration [5

    “The development of a set of explanatory ideas around normalization has shifted from an initial set of empirical generalizations presented as synthetic propositions or assertions [17], to a robust conceptual model that presented generalizable propositions [7], and finally to a middle-range theory that offers a set of mechanism-based explanations for processes of implementation, embedding, and integ”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [17] May CR, Harrison R, Finch T, MacFarlane A, Mair FS, Wallace P: Understanding the normalization of telemedicine services through qualitative evaluation. J Am Med Informat Ass. 2003, 10 (6): 596-604. 10.1197/jamia.M1145. source

      Not checked in the free run.

    • cites [7] May C: A rational model for assessing and evaluating complex interventions in health care. BMC Health Serv Res. 2006, 6: 86-10.1186/1472-6963-6-86. source

      Not checked in the free run.

    • cites [5] May C, Finch T: Implementation, embedding, and integration: an outline of Normalization Process Theory. Sociology. 2009,

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The purpose of road testing NPT was not to formally test the theory, but rather to demonstrate that it was fit to be tested.

    “It is important to emphasise that the purpose of this work was not to formally test the theory, but rather to demonstrate that it was fit to be tested:”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Study design and conductnone given

    NPT has been developed through procedures that were properly sceptical and critical, and which were opened to review at each stage of development.

    “Normalization Process Theory has been developed through procedures that were properly sceptical and critical, and which were opened to review at each stage of development.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    This theory-building process has been a highly collaborative one, in which many people have made very important contributions to the development of theoretical explanation.

    “This theory-building process has been a highly collaborative one, in which many people have made very important contributions to the development of theoretical explanation.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    'Road testing' NPT required establishing that its constructs actually defined mechanisms, components, and investments that could all be prospectively revealed by empirical research, and that these could be characterised in a stable way.

    “To summarise, 'road testing' NPT required that we establish that its constructs actually defined mechanisms, components, and investments that could all be prospectively revealed by empirical research, and that these could be characterised in a stable way.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    When factual accounts of theory development exist, they often take the form of personal histories [56], or accounts of particular social networks [57].

    “When they exist, these often take the form of personal histories [56], or accounts of particular social networks [57].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [56] Rogers EM: A prospective and retrospective look at the diffusion model. J Health Communicat. 2004, 9: 13-19. 10.1080/10810730490271449. source

      Not checked in the free run.

    • cites [57] Collins HM: Tacit knowledge in scientific networks. Science in context: readings in the sociology of science. Edited by: Barnes B, Edge D. 1982, Buckingham: Open University Press, 44-64.

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    NPT is presented as a general, and generalizable, middle-range theory that seeks to explain the processes of implementation, embedding, and integration of material practices in formally defined contexts, relates these processes to causal social mechanisms, identifies components of those mechanisms, and defines the investments required to energize them.

    “We therefore presented it as a general, and generalizable, middle-range theory, NPT [5,41]), that seeks to explain the processes of implementation, embedding, and integration of material practices in formally defined contexts, relates these processes to causal social mechanisms [42], identifies components of those mechanisms, and defines the investments that are required to energize them.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [5] May C, Finch T: Implementation, embedding, and integration: an outline of Normalization Process Theory. Sociology. 2009,

      Not checked in the free run.

    • cites [41] May C: Mundane Medicine, Therapeutic Relationships, and the Clinical Encounter.'. Handbook of the Sociology of Health, Illness, and Healing: A Blueprint for the 21st Century. Edited by: Pescosolido B, Martin JA, Rogers A. New York: Springer

      Not checked in the free run.

    • cites [42] Hedstrom P: Dissecting the Social: On the Principles of Analytical Sociology. 2005, Cambridge: Cambridge University Press source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisereasoning

    NPT is a sociological theory that focuses on the contribution of social action to implementation, embedding, and integration.

    “Although it has been developed through a series of multi-disciplinary collaborations, NPT is a sociological theory in that it takes as its focus the contribution of social action to implementation, embedding, and integration.”
    Quote in the paperSubstantial claim
48 of 48

  • The paper relies on this without support.

    It is important to show that a theory has been derived through rigorous methods, applied sceptically, and critically assessed.

    “It is important to show that the theory has been derived through processes that have involved the application of rigorous methods, that these methods have been applied in a properly sceptical way, and that the outcomes of their application have been critically assessed.”

  • The paper relies on this without support.

    The limited scope, conceptual range, and claims of middle-range theories make them practically workable in analysing practice.

    “The limited scope, conceptual range, and claims of middle-range theories are important because they are what make them practically workable in analysing practice.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Data analysis called both quantitative and qualitative

    Minor

    The methods identify quantitative data analysis as one of two pieces of road-testing work, but the corresponding subsection describes qualitative data analysis.

  • Conflicting dates for theory development

    Minor

    The abstract dates the development of the theory to 1998-2008, while the Background dates the development of NPT to 2000-2009.

2 of 2

Cites

Flagged first, then by citations

1 of the 62 references couldn’t be matched to a known paper.

Research works printed but not linked: 8

  1. Ashford AJ: Behavioural change in professional practice: supporting the development of effective implementation strategies. 2002, Newcastle upon Tyne: Centre for Health Services Research
  2. May C, Finch T: Implementation, embedding, and integration: an outline of Normalization Process Theory. Sociology. 2009,
  3. Glaser BG, Strauss A: The discovery of grounded theory. 1967, Chicago: Aldine
  4. Goldthorpe JH: On Sociology: Critique and Program. 2006, Stanford: Stanford University Press
  5. Hechter M, Horne C: Theory is explanation. Theories of social order. Edited by: Hechter M, Horne C. 2003, Stanford CA: Stanford University Press
  6. May C: Mundane Medicine, Therapeutic Relationships, and the Clinical Encounter.'. Handbook of the Sociology of Health, Illness, and Healing: A Blueprint for the 21st Century. Edited by: Pescosolido B, Martin JA, Rogers A. New York: Springer
  7. Mair F, May C, Murray E, Finch T, Anderson G, O'Donnell C, Wallace P, Sullivan F: Understanding the Implementation and Integration of E-Health Services. 2009, London: National Co-ordinating Centre for the National Institute for Health Research Service Delivery and Organisation Programme (NCCSDO)
  8. Wilkes S: Evaluation of open access hysterosalpingography in the initial management of infertility in primary care. 2007, Unpublished PhD Thesis, University of Sunderland

Cited by

Sorted by citations

Related

Authors
May, C. R., Mair, F., Finch, T., MacFarlane, A., Dowrick, C., Treweek, S., Rapley, T., Ballini, L., Ong, B. N., Rogers, A., Murray, E., Elwyn, G., Légaré, F., Gunn, J., & Montori, V. M.
Affiliations
  • Newcastle University (GB)
  • University of Glasgow (GB)
  • Ollscoil na Gaillimhe – University of Galway (IE)
  • University of Liverpool (GB)
  • University of Dundee (GB)
  • Agenzia Sanitaria e Sociale Regionale (IT)
  • Keele University (GB)
  • University of Manchester (GB)
  • University College London (GB)
  • Cardiff University (GB)
  • Université Laval (CA)
  • The University of Melbourne (AU)
Corresponding author
May, Carl R
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2009-05-21
Volume
4
Issue
1
Pages
29-29
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/1748-5908-4-29
PMC
PMC2693517
OpenAlex
W2124199620
Cited by
1,409
References
62
Citations by year
2026: 113 · 2025: 133 · 2024: 156 · 2023: 112 · 2022: 124 · 2021: 143 · 2020: 164 · 2019: 63 · 2018: 79 · 2017: 68 · 2016: 63 · 2015: 52 · 2014: 52 · 2013: 23 · 2012: 25
FWCI
37.64
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Discovery Research Portal (University of Dundee) (publishedVersion, cc-by)
  • ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
  • Northumbria Research Link (Northumbria University) (acceptedVersion, other-oa)
  • Arrow@dit (Dublin Institute of Technology) (acceptedVersion)
  • BIBSYS Brage (BIBSYS (Norway)) (acceptedVersion, cc-by)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Arrow@dit (Dublin Institute of Technology) (submittedVersion)
  • ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
  • Radboud Repository (Radboud University) (submittedVersion)
  • University of Limerick Institutional Repository (University of Limerick) (submittedVersion, cc-by-nc-sa)
  • Radboud Repository (Radboud University) (submittedVersion, other-oa)
  • Newcastle University ePrints (Newcastle Univesity)
Funders
National Institute for Health and Care Research (RP-PG-0407-10386)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Education › Qualitative Research Methods and Applications
  • Social Sciences › Sociology and Political Science › Information Systems Theories and Implementation
Keywords
Normalization Process Theory, theory development, implementation theory, middle-range theory, empirical generalization, theory testing

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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