The DOI matches its Crossref record; 61 of the 62 references it cites were found in a registry or an index; none of the 73 sources its claims cite is checked for support yet.
Development of a theory of implementation and integration: Normalization Process Theory
Open accessAbstract
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.
Overview
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.
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Claims the paper makes
42 Not checked yet · 21 Own interpretation · 21 No basis given · 7 Own method · 2 Own result
In the paper
“At this stage, the NPM synthesized empirical generalizations from groups of related studies, and producing taxonomies, maps of relations between concepts, and generalizations [24].”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase two: Building an applied theoretical model
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“'Road testing' showed that it had utility in explaining factors that promoted and inhibited collective action in operationalizing practices.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Research synthesis
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In fact, it extends it.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Relationship between the NPM and NPT
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The formal theory (NPT) does not conflict with the applied model (NPM) from which it was drawn.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Relationship between the NPM and NPT
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Reviews of relevant theory published at that time [1-4] explicated these explanatory gaps.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background > Why was NPT developed?
What the sources say
- Not checked yetcites [1] Ashford AJ: Behavioural change in professional practice: supporting the development of effective implementation strategies. 2002, Newcastle upon Tyne: Centre for Health Services Research
- Not checked yetcites [2] Wensing M, Bosch M, Foy R, Weijden van der T, Eccles M, Grol R: Factors in theories on behaviour change to guide implementation and quality improvement in healthcare. 2005, Nijmegen: University of Nijmegen
- Not checked yetcites [3] Grol R, Wensing M, Hulscher M, Eccles M: Theories on implementation of change in healthcare. 2004, Nijmegan: WOK
- Not checked yetcites [4] Grol RP, Bosch M, Hulscher M, Eccles M, Wensing M: Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Quarterly. 2007, 85 (1): 93-138. 10.1111/j.1468-0009.2007.00478.x. source
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In other words, they were observational rather than explanatory.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase one: Developing empirical generalizations
plain- Asserted: passes — The authors put it forward as true.
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- Probably not a substantial claim. 38
- It may state two separate claims as one. 20
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The empirical generalizations produced by these processes were general conclusions about regularities in the data, and were framed as formal propositions.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase one: Developing empirical generalizations
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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].”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Research synthesis
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, we can say that the processes of theoretical development described in this paper were opportunistic and organic in the beginning.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background > Why was NPT developed?
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“'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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Refining and testing the NPM
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“These were linked together by sociological explanations of the relations between its constructs, their dimensions, and components.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase two: Building an applied theoretical model
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“We show how these procedures led to a set of propositions that possessed sufficient face validity and conceptual robustness to warrant formal testing.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase three: Making a formal theory
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“This process was important because it paralleled the final revisions of the NPT as subsequently accepted for publication.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Road testing the NPT
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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)”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Relationship between the NPM and NPT
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The constructs of the NPM are central to the formal theory and constitute its collective action component.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Relationship between the NPM and NPT
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase three: Making a formal theory
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Research synthesis
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“They referred instead to generic properties of implementation processes and offered an explanation of them without reference to specific social contexts.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase three: Making a formal theory
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Taken together these set the scene for possible empirical verification.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase two: Building an applied theoretical model
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Qualitative data analysis
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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].”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background > Why was NPT developed?
What the sources say
- Not checked yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background > What is NPT?
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It is a theory of action.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background > What is NPT?
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background > What is NPT?
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background > What is NPT?
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“1. Practices become routinely embedded – or normalized – in social contexts as the result of people working, individually and collectively, to enact them.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background > What is NPT?
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background > What is NPT?
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“1. Implementation, by which we mean the social organization of bringing a practice or practices into action.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background > What is NPT?
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Abstract > Background
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
In the paper
“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].”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Refining and testing the NPM
What the sources say
- Not checked yetcites [26] Goldthorpe JH: On Sociology: Critique and Program. 2006, Stanford: Stanford University Press
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Refining and testing the NPM
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This was framed as a set of analytic propositions (see Appendix 2) that were supported by rigorous data analysis.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase two: Building an applied theoretical model
plain- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Abstract > Background
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase one: Developing empirical generalizations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background > What is NPT?
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Results > The importance of transparency
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Results > The importance of transparency
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The processes of theory development described here have included changes in scope, as well as method.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Results > The changing scope of the theory
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Such theories sometimes seem to spring fully-formed from critiques of the literature, or by assertions about prior theories.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Results > The importance of transparency
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“The goal of theory-building at this level is to isolate the generic properties of phenomena and understand their operation [37].”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase three: Making a formal theory
What the sources say
- Not checked yetcites [37] Turner JH: Analytical Theorizing. Social Theory Today. Edited by: Giddens A, Turner J. 1987, Cambridge: Polity Press, 156-194.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We then had to demonstrate that these constructs could be operationalized in a way that conferred an analytic advantage.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Road testing the NPT
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Conclusion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Road testing the NPT
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase three: Making a formal theory
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“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].”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Relationship between the NPM and NPT
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [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 yetcites [46] Wilkes S: Evaluation of open access hysterosalpingography in the initial management of infertility in primary care. 2007, Unpublished PhD Thesis, University of Sunderland
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Development of a theory of implementation and integration: Normalization Process Theory > Results > The changing scope of the theory
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [5] May C, Finch T: Implementation, embedding, and integration: an outline of Normalization Process Theory. Sociology. 2009,
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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:”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Road testing the NPT
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Abstract > Conclusion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Conclusion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Road testing the NPT
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“When they exist, these often take the form of personal histories [56], or accounts of particular social networks [57].”
§ Development of a theory of implementation and integration: Normalization Process Theory > Results > The importance of transparency
What the sources say
- Not checked yetcites [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 yetcites [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.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Phase three: Making a formal theory
What the sources say
- Not checked yetcites [5] May C, Finch T: Implementation, embedding, and integration: an outline of Normalization Process Theory. Sociology. 2009,
- Not checked yetcites [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 yetcites [42] Hedstrom P: Dissecting the Social: On the Principles of Analytical Sociology. 2005, Cambridge: Cambridge University Press source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > NPT is a middle-range theory
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
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.”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“NPT is a theory of implementation that focuses on what people—both individuals and groups—do rather than what they believe or intend, and it has been built up from studies of practice in many different healthcare systems.”
From Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review (2018) · cites this paper as [8]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“The development of NPT first involved the iterative development of a robust generic theory of implementation [5–9, 11, 12].”
From Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review (2018) · cites this paper as [8]
The cited source says what the claim attributes to it.
In the citing paper
“In the second iteration of the theory—Normalization Process Theory (NPT) [7, 8]—we characterised mechanisms (coherence, cognitive participation, collective action and reflexive monitoring) that motivate and shape implementation processes and explained their operation.”
From Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review (2018) · cites this paper as [8]
The cited source says what the claim attributes to it.
In the citing paper
“the content of our framework (data derived from primary care) is comparable and overlaps considerably with the CFIR which is not primary care specific and has resonance with NPT.”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [92]
The cited source says what the claim attributes to it.
In the citing paper
“NPT is a theory of implementation that focuses on what people—both individuals and groups—do rather than what they believe or intend, and it has been built up from studies of practice in many different healthcare systems.”
From Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review (2018) · cites this paper as [8]
The cited source says what the claim attributes to it.
In the citing paper
“Normalization Process Theory (NPT) identifies, characterises and explains key mechanisms that promote and inhibit the implementation, embedding and integration of new health techniques, technologies and other complex interventions.”
From Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review (2018) · cites this paper as [8]
The cited source says what the claim attributes to it.
In the citing paper
“we have argued that theories are conceptual toolkits that can be used flexibly to deal with practical problems.”
From Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review (2018) · cites this paper as [8]
The cited source says what the claim attributes to it.
In the citing paper
“For example, the social influences and environmental context and resource domains point to organisational and systems context for change and can be further elaborated, e.g. by Normalisation Process Theory [66], the Consolidated Framework For Implementation Research [67] and the Yorkshire Contributory Factors Framework [68].”
From A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems (2017) · cites this paper as [66]
In the citing paper
“One that has been applied in healthcare is normalisation process theory [77, 78], which acknowledges the interaction of actors (recipients) within their context and proposes four constructs titled coherence, cognitive participation, collective action and reflexive monitoring as the generative mechanisms required to routinely embed innovations.”
From PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice (2015) · cites this paper as [78]
In the citing paper
“Normalization includes supporting staff to make sense of the new technology in the context of their work; engaging them to participate; coordinating their implementation efforts; and monitoring benefits and costs (23).”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [23]
In the citing paper
“Previously published approaches primarily focus on implementation, although the details of implementation theory, implementation strategy or a comprehensive implementation process are often neglected (e.g., [14, 53, 84, 85]).”
From Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework (2017) · cites this paper as [84]
In the citing paper
“There is currently no published review of its empirical application, but it has been seen to have been applied to good effect in a number of social and health-care settings.121,134,135”
From ReseArch with Patient and Public invOlvement: a RealisT evaluation – the RAPPORT study (2015) · cites this paper as [135]
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.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Refining and testing the NPM
“This consisted of two main pieces of work, quantitative data analysis and research synthesis.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Methods > Qualitative data analysis
“### Qualitative data analysis We integrated the NPM in qualitative data analysis in three large studies”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Development of a theory of implementation and integration: Normalization Process Theory > Abstract > Methods
“Between 1998 and 2008, we developed a theory.”
§ Development of a theory of implementation and integration: Normalization Process Theory > Background
“this paper described the processes by which one of them – Normalization Process Theory (or NPT) [5-7] – was developed between 2000 and 2009.”
Citations
Cites
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Qualitative Analysis for Social Scientists
Strauss, A. L. (1987) · doi:10.1017/cbo9780511557842 · Cited by 12,277 · cited 2×
“Between 2003 and 2007, using grounded theory-building techniques [21,22], an applied theoretical model of normalization processes – the Normalization Process Model, or NPM, [7] – was derived from earlier empirical generalizations across all four domains of study.”
(1990) · Cited by 11,110
Social Theory and Social Structure
Ross, E. J., & Merton, R. Κ. (1958) · The American Catholic Sociological Review · doi:10.2307/3709394 · Cited by 10,318
Research works printed but not linked: 8
- Ashford AJ: Behavioural change in professional practice: supporting the development of effective implementation strategies. 2002, Newcastle upon Tyne: Centre for Health Services Research
- May C, Finch T: Implementation, embedding, and integration: an outline of Normalization Process Theory. Sociology. 2009,
- Glaser BG, Strauss A: The discovery of grounded theory. 1967, Chicago: Aldine
- Goldthorpe JH: On Sociology: Critique and Program. 2006, Stanford: Stanford University Press
- Hechter M, Horne C: Theory is explanation. Theories of social order. Edited by: Hechter M, Horne C. 2003, Stanford CA: Stanford University Press
- 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
- 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)
- 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
Atkins, L., Francis, J., Islam, R., O’Connor, D., Patey, A., Ivers, N., Foy, R., Duncan, E. M., Colquhoun, H., Grimshaw, J. M., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0605-9 · Cited by 3,819
Murray, E., Treweek, S., Pope, C., MacFarlane, A., Ballini, L., Dowrick, C., Finch, T., Kennedy, A., Mair, F., O'Donnell, C., et al. (2010) · BMC Medicine · doi:10.1186/1741-7015-8-63 · Cited by 1,478
“NPT [19,20] identifies factors that promote and inhibit the routine incorporation of complex interventions into everyday practice.”
Self-citationKwasnicka, D., Dombrowski, S. U., White, M., & Sniehotta, F. (2016) · Health Psychology Review · doi:10.1080/17437199.2016.1151372 · Cited by 1,476
“May & Finch, 2009; May et al., 2009).”
Harvey, G., & Kitson, A. (2015) · Implementation Science · doi:10.1186/s13012-016-0398-2 · Cited by 1,271
Implementation, context and complexity
May, C. R., Johnson, M., & Finch, T. (2016) · Implementation Science · doi:10.1186/s13012-016-0506-3 · Cited by 978
“As in our earlier work [22, 24], we define implementation as follows:”
BackgroundMethodSelf-citationPfadenhauer, L. M., Gerhardus, A., Mozygemba, K., Lysdahl, K. B., Booth, A., Hofmann, B., Wahlster, P., Polus, S., Burns, J., Brereton, L., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0552-5 · Cited by 1,016
“The implementation process refers to the social processes, through which interventions are operationalised in an organisation or community [84].”
BackgroundMay, C. R., Cummings, A., Girling, M., Bracher, M., Mair, F. S., May, C. M., Murray, E., Myall, M., Rapley, T., & Finch, T. (2018) · Implementation Science · doi:10.1186/s13012-018-0758-1 · Cited by 683
“Agents: What is the work of implementing a new technique, technology or organisational intervention? In the second iteration of the theory—Normalization Process Theory (NPT) [7, 8]—we characterised mechanisms (coherence, cognitive participation, collective action and reflexive monitoring) that motivate and shape imple…”
BackgroundSelf-citationShippee, N. D., Shah, N. D., May, C. R., Mair, F. S., & Montori, V. M. (2012) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2012.05.005 · Cited by 728
Self-citationO’Connor, S., Hanlon, P., O’Donnell, C. A., Garcia, S., Glanville, J., & Mair, F. S. (2016) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-016-0359-3 · Cited by 636
Self-citationMay, C. R., Eton, D. T., Boehmer, K., Gallacher, K., Hunt, K., MacDonald, S., Mair, F. S., May, C. M., Montori, V. M., Richardson, A., et al. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-281 · Cited by 720
Self-citationTowards a general theory of implementation
May, C. (2013) · Implementation Science · doi:10.1186/1748-5908-8-18 · Cited by 656
“This model was then developed into Normalization Process Theory, a generic and middlerange theory of implementation [8,10].”
BackgroundInfluentialSelf-citationMair, F. S., May, C., O’Donnell, C., Finch, T., Sullivan, F., & Murray, E. (2012) · Bulletin of the World Health Organization · doi:10.2471/blt.11.099424 · Cited by 553
“Second, we have interpreted our results in the light of an explanatory framework – Normalization Process Theory (NPT) 5,6 – that specifies mechanisms of importance in implementation processes.”
BackgroundMethodSelf-citationLau, R., Stevenson, F., Ong, B. N., Dziedzic, K., Treweek, S., Eldridge, S., Everitt, H., Kennedy, A., Qureshi, N., Rogers, A., et al. (2015) · Implementation Science · doi:10.1186/s13012-016-0396-4 · Cited by 533
“NPT was constructed from a sociological perspective [91, 92] and the Theoretical Domains Framework (TDF) which is an integrative framework of theories of behaviour change”
MethodSelf-citationMurphy, M., Scott, L. J., Salisbury, C., Turner, A., Scott, A., Denholm, R., Lewis, R., Iyer, G., Macleod, J., & Horwood, J. (2021) · British Journal of General Practice · doi:10.3399/bjgp.2020.0948 · Cited by 486
“Normalisation Process Theory (NPT) 22 was used to structure the analysis of the implementation of remote consulting.”
MethodInfluentialJohnson, M. J., & May, C. R. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008592 · Cited by 550
Self-citationEvaluating patient and stakeholder engagement in research: moving from theory to practice
Esmail, L., Moore, E., & Rein, A. (2015) · Journal of Comparative Effectiveness Research · doi:10.2217/cer.14.79 · Cited by 502
McEvoy, R., Ballini, L., Maltoni, S., O’Donnell, C. A., Mair, F. S., & MacFarlane, A. (2014) · Implementation Science · doi:10.1186/1748-5908-9-2 · Cited by 413
Self-citationClinician Acceptance is the Key Factor for Sustainable Telehealth Services
Wade, V. A., Eliott, J. A., & Hiller, J. E. (2014) · Qualitative Health Research · doi:10.1177/1049732314528809 · Cited by 410
“…been constructed as a formal meso-level theory with 16 major concepts covering the mechanisms people use to implement new work practices, how these become routinely embedded in health care services, and what investments are needed to ensure the new work practices are maintained (May et al., 2009).”
BackgroundThe Handbook of Behavior Change
Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N. E., & Lintunen, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318 · Cited by 446
Qualitative approaches to use of the RE-AIM framework: rationale and methods
Holtrop, J. S., Rabin, B. A., & Glasgow, R. E. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-2938-8 · Cited by 404
“[37] Examining the main domains of theories can guide an inquiry to make sure relevant factors for maintenance are not overlooked.”
BackgroundNormalising the “new normal”: Changing tech-driven work practices under pandemic time pressure
Carroll, N., & Conboy, K. (2020) · International Journal of Information Management · doi:10.1016/j.ijinfomgt.2020.102186 · Cited by 433
“Cognitive participation draws focus on tech-driven work practices that employees do to build and sustain the new practice during the Table 1 Applying NPT to Examine Changing Tech-Driven Work Practices (adapted from May & Finch, 2009; May et al., 2009).”
InfluentialEton, D. T., de Oliveira, D. R., Egginton, J. S., Ridgeway, J. L., Odell, L., May, C. R., & Montori, V. M. (2012) · Patient Related Outcome Measures · doi:10.2147/prom.s34681 · Cited by 361
“Prior studies of treatment impact and satisfaction 10,11,23 and May et al’s normalization process theory 2,24 informed the questions.”
Self-citationGallacher, K., May, C. R., Montori, V. M., & Mair, F. S. (2011) · The Annals of Family Medicine · doi:10.1370/afm.1249 · Cited by 356
Self-citationPerry, C. K., Damschroder, L. J., Hemler, J. R., Woodson, T. T., Ono, S. S., & Cohen, D. J. (2019) · Implementation Science · doi:10.1186/s13012-019-0876-4 · Cited by 288
Finch, T. L., Girling, M., May, C. R., Mair, F. S., Murray, E., Treweek, S., McColl, E., Steen, I. N., Cook, C., Vernazza, C. R., et al. (2018) · BMC Medical Research Methodology · doi:10.1186/s12874-018-0591-x · Cited by 337
Self-citationBleijenberg, N., de Man-van Ginkel, J. M., Trappenburg, J. C. A., Ettema, R. G. A., Sino, C. G., Heim, N., Hafsteindóttir, T. B., Richards, D. A., & Schuurmans, M. J. (2018) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2017.12.001 · Cited by 334
“For example, the Normalization Process Theory (NPT) can help to understand implementation of complex interventions because it focuses on action rather than attitudes (May et al., 2009; May, 2013).”
BackgroundBarker, F., Atkins, L., & de Lusignan, S. (2016) · International Journal of Audiology · doi:10.3109/14992027.2015.1120894 · Cited by 329
“For example, normalization process theory (NPT) has been proposed as a method for analysing healthcare professional behaviour and embedding new clinical behaviours into a clinical routine (May et al, 2009).”
MethodGitlin, L. N., Marx, K., Stanley, I. H., & Hodgson, N. (2015) · The Gerontologist · doi:10.1093/geront/gnu123 · Cited by 336
Adoption of telemedicine: from pilot stage to routine delivery
Zanaboni, P., & Wootton, R. (2012) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-12-1 · Cited by 344
“More recently, May and colleagues developed a Normalization Process Theory (NPT) to explain the implementation, embedding and integration of complex health interventions into everyday practice [42].”
BackgroundWhy (we think) facilitation works: insights from organizational learning theory
Berta, W., Cranley, L., Dearing, J. W., Dogherty, E. J., Squires, J. E., & Estabrooks, C. A. (2015) · Implementation Science · doi:10.1186/s13012-015-0323-0 · Cited by 286
“We know that this requires continuous, collective investment by those making the change [44], but we do not know precisely which facilitation approaches, and which structures and processes, must be in place to maintain practice changes.”
BackgroundLiberati, E. G., Ruggiero, F., Galuppo, L., Gorli, M., González-Lorenzo, M., Maraldi, M., Ruggieri, P., Polo Friz, H., Scaratti, G., Kwag, K. H., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0644-2 · Cited by 301
“Sociology, Anthropology, Social Psychology, Philosophy Normalization Process Theory [56], Technological sense-making [57, 58], Sociotechnical Systems [59], Actor Network Theory [60], Communities of Practice [46] Technology adoption and spread is conceived as a social practice , constantly produced and re-produced thro…”
ReseArch with Patient and Public invOlvement: a RealisT evaluation – the RAPPORT study
Wilson, P., Mathie, E., Keenan, J., McNeilly, E., Goodman, C., Howe, A., Poland, F., Staniszewska, S., Kendall, S., Munday, D., et al. (2015) · Health Services and Delivery Research · doi:10.3310/hsdr03380 · Cited by 297
“There is currently no published review of its empirical application, but it has been seen to have been applied to good effect in a number of social and health-care settings.(121,134,135) Of relevance in the RAPPORT study, and discussed in the following sections, is that case study methods have been seen to be more rob…”
Changing Behavior Using the Theory of Planned Behavior
Ajzen, I., & Schmidt, P. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.002 · Cited by 346
Why is it difficult to implement e-health initiatives? A qualitative study
Murray, E., Burns, J., May, C., Finch, T., O'Donnell, C., Wallace, P., & Mair, F. (2011) · Implementation Science · doi:10.1186/1748-5908-6-6 · Cited by 270
Self-citationCollaborative deliberation: A model for patient care
Elwyn, G. J., Lloyd, A., May, C. R., van der Weijden, T., Stiggelbout, A. M., Edwards, A., Frosch, D. L., Rapley, T., Barr, P. J., Walsh, T., et al. (2014) · Patient Education and Counseling · doi:10.1016/j.pec.2014.07.027 · Cited by 268
“, used for describing the process of ‘normalization’, the embedding of innovations into routine practice [34,35].”
MethodSelf-citationRosbach, M., & Andersen, J. S. (2017) · PLoS ONE · doi:10.1371/journal.pone.0179916 · Cited by 245
“The term”work” or”workload” was used to describe the BoT in several studies [27–30], in which the Normalization Process Theory was used to explain how patients performed that work and how it became embedded in everyday practice.”
BackgroundInfluentialMay, C. R., Albers, B., Bracher, M., Finch, T. L., Gilbert, A. W., Girling, M., Greenwood, K., MacFarlane, A. E., Mair, F. S., May, C., et al. (2022) · Implementation Science · doi:10.1186/s13012-022-01191-x · Cited by 283
“It also forms a translational framework for researching and evaluating implementation processes and thus complements other resources for NPT researchers such as the NPT Toolkit and the NOMAD survey instrument [17, 19, 21, 22].”
MethodSelf-citationMay, C. R., Finch, T. L., Ballini, L., MacFarlane, A. E., Mair, F. S., Murray, E., Treweek, S., & Rapley, T. (2011) · Arrow@dit (Dublin Institute of Technology) · doi:10.34961/10032 · Cited by 235
Self-citationUsing a Theory-Driven Conceptual Framework in Qualitative Health Research
MacFarlane, A. E., & Brún, M. O.-D. (2011) · Qualitative Health Research · doi:10.1177/1049732311431898 · Cited by 263
“…conceptual framework, the Normalization Process Model (May, 2006), which was generated over time from a series of inductive qualitative studies (see May et al., 2009), to inform the design and analysis of our qualitative evaluation of general practitioners’ uptake of a free, pilot, language…”
MethodSelf-citationIntegrating telecare for chronic disease management in the community: What needs to be done?
May, C. R., Finch, T. L., Cornford, J., Exley, C., Gately, C., Kirk, S., Jenkings, K. N., Osbourne, J., Robinson, A. L., Rogers, A., et al. (2011) · BMC Health Services Research · doi:10.1186/1472-6963-11-131 · Cited by 220
“Both kinds of data were then subjected to an integrative analysis, and informed by Normalization Process Theory (NPT) [29,30].”
Self-citationContext and implementation: A concept analysis towards conceptual maturity
Pfadenhauer, L. M., Mozygemba, K., Gerhardus, A., Hofmann, B., Booth, A., Lysdahl, K. B., Tummers, M., Burns, J., & Rehfuess, E. A. (2015) · Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2015.01.004 · Cited by 189
Sustainability of public health interventions: where are the gaps?
Walugembe, D. R., Sibbald, S. L., Ber, M. J. L., & Kothari, A. R. (2019) · Health Research Policy and Systems · doi:10.1186/s12961-018-0405-y · Cited by 226
Workplace violence experienced by nursing students: A UK survey
Tee, S., Üzar‐Özçetin, Y. S., & Russell-Westhead, M. (2016) · Nurse Education Today · doi:10.1016/j.nedt.2016.03.014 · Cited by 202
“NPT has three core elements; 1, bringing a practice into action (implementation), 2, practice become routinely incorporated in everyday work (embedding) and 3, practice being reproduced and sustained among the social matrices of an organization (integration) (May and Finch 2009, May et al. 2009).”
Agency and implementation: Understanding the embedding of healthcare innovations in practice
May, C. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2012.11.021 · Cited by 189
“Elsevier Ltd. NPT is a middle range theory that focuses on what people do e their agentic contributions to the social processes by which innovations are implemented, embedded and integrated in their social contexts (May, 2006; May & Finch, 2009; May et al., 2009).”
BackgroundSelf-citationConn, L. G., McKenzie, M., Pearsall, E., & Mcleod, R. (2015) · Implementation Science · doi:10.1186/s13012-015-0289-y · Cited by 171
“We selected the NPT because it is chiefly concerned with how new practices and processes are integrated, embedded, and sustained into routine practice.”
MethodInfluentialCranley, L. A., Cummings, G. G., Profetto‐McGrath, J., Tóth, F., & Estabrooks, C. A. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-014384 · Cited by 216
Rapley, T., Girling, M., Mair, F. S., Murray, E., Treweek, S., McColl, E., Steen, I. N., May, C. R., & Finch, T. L. (2018) · BMC Medical Research Methodology · doi:10.1186/s12874-018-0590-y · Cited by 193
Self-citationWebb, R., Uddin, N., Ford, E. M., Easter, A., Shakespeare, J., Roberts, N. W., Alderdice, F. A., Coates, R., Hogg, S., Cheyne, H., et al. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30467-3 · Cited by 217
Greenhalgh, T., Rosen, R., Shaw, S. E., Byng, R., Faulkner, S., Finlay, T., Grundy, E., Husain, L., Hughes, G., Leone, C., et al. (2021) · Frontiers in Digital Health · doi:10.3389/fdgth.2021.726095 · Cited by 173
“This domain also includes the complex question of how technologies become—or why they fail to become—taken up and maintained in organizations (23).”
BackgroundLeppin, A. L., Montori, V. M., & Gionfriddo, M. R. (2015) · Healthcare · doi:10.3390/healthcare3010050 · Cited by 196
“May and colleagues have described the work involved in acquiring new routines and the ways in which patients are able (or unable) to enact prescribed work into their lives [10,11].”
BackgroundSelf-citationRaine, R., Fitzpatrick, R. M., Barratt, H., Bevan, G., Black, N. A., Boaden, R., Bower, P., Campbell, M., Denis, J., Devers, K. J., et al. (2016) · Health Services and Delivery Research · doi:10.3310/hsdr04160 · Cited by 197
Finch, T. L., Rapley, T., Girling, M., Mair, F. S., Murray, E., Treweek, S., McColl, E., Steen, I. N., & May, C. R. (2013) · Implementation Science · doi:10.1186/1748-5908-8-43 · Cited by 177
“NPT [10-14] is concerned with the generative processes that underpin three core problems: implementation (bringing a practice or practices into action); embedding, (when a practice or practices may be routinely incorporated in everyday work of individuals and groups); and integration (when a practice or practices are…”
BackgroundSelf-citationO’Brien, R., Wyke, S., Guthrie, B., Watt, G. C. M., & Mercer, S. W. (2010) · Chronic Illness · doi:10.1177/1742395310382461 · Cited by 176
“Relating the Findings to Existing Literature Patients’ Struggles There is the suggestion, which needs further exploration in patient interviews, that socioeconomic factors may further impact on the ‘tensions’ and ‘moral dilemmas’ those with multimorbidity have been reported to experience in their efforts to manage ‘we…”
BackgroundDemain, S., Gonçalves, A.-C., Areia, C., Oliveira, R., Marcos, A. J., Marques, A., Parmar, R., & Hunt, K. (2015) · PLOS ONE · doi:10.1371/journal.pone.0125457 · Cited by 173
“The focus on ‘treatment workload’ has usefully led to the application of Normalisation Process Theory (NPT) [13] as an analytical framework and the development of a taxonomy of physical, cognitive and interactional tasks contributing to treatment burden [11].”
Implementation science in resource-poor countries and communities
Yapa, H. M., & Bärnighausen, T. (2018) · Implementation Science · doi:10.1186/s13012-018-0847-1 · Cited by 170
Rycroft‐Malone, J., Burton, C. R., Wilkinson, J. E., Harvey, G., McCormack, B. G., Baker, R., Dopson, S., Graham, I. D., Staniszewska, S. H., Thompson, C. A., et al. (2015) · Implementation Science · doi:10.1186/s13012-016-0380-z · Cited by 173
Osteoarthritis: Models for appropriate care across the disease continuum
Allen, K. D., Choong, P., Davis, A. M., Dowsey, M. M., Dziedzic, K., Emery, C. A., Hunter, D. J., Losina, E., Page, A. E., Roos, E. M., et al. (2016) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2016.09.003 · Cited by 171
Ridgeway, J. L., Eton, D. T., Egginton, J. S., Tiedje, K., Linzer, M., Boehm, D. H., Poplau, S., de Oliveira, D. R., Odell, L., & Montori, V. M. (2014) · Patient Preference and Adherence · doi:10.2147/ppa.s58014 · Cited by 170
Self-citationPeek, S. T. M., Wouters, E., Luijkx, K. G., & Vrijhoef, H. J. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5253 · Cited by 171
“NPT addresses “the factors needed for successful implementation and integration of interventions into routine work” [49] and consists of four main components: coherence (ie, meaning and sense making by stakeholders); cognitive participation (ie, commitment and engagement by stakeholders);…”
A scoping review of full-spectrum knowledge translation theories, models, and frameworks
Esmail, R., Hanson, H. M., Holroyd-Leduc, J. M., Brown, S., Strifler, L., Straus, S. E., Niven, D. J., & Clement, F. M. (2020) · Implementation Science · doi:10.1186/s13012-020-0964-5 · Cited by 168
“May CR, Mair F, Finch T, MacFarlane A, Dowrick C, Treweek S, et al. Development of a theory of implementation and integration: Normalization Process Theory.”
MethodInfluentialWhy are we failing to implement effective therapies in cardiovascular disease?
Nieuwlaat, R., Schwalm, J.-D., Khatib, R., & Yusuf, S. (2013) · European Heart Journal · doi:10.1093/eurheartj/ehs481 · Cited by 155
Overbeck, G., Davidsen, A. S., & Kousgaard, M. B. (2016) · Implementation Science · doi:10.1186/s13012-016-0519-y · Cited by 162
“According to NPT, the mechanisms of implementation processes can be captured through four theoretical dimensions [11, 12]: (1) coherence: how actors understand and make sense of an intervention which is to be implemented in the organization; (2) cognitive participation: how actors engage in the implementation process;…”
BackgroundMethodHuddlestone, L., Turner, J., Eborall, H., Hudson, N., Davies, M. J., & Martin, G. P. (2020) · BMC Family Practice · doi:10.1186/s12875-020-01107-y · Cited by 154
Keyworth, C., Hart, J., Armitage, C. J., & Tully, M. P. (2018) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-018-0661-3 · Cited by 148
Ibrahim, K., May, C. R., Patel, H. P., Baxter, M. A., Sayer, A. A., & Roberts, H. C. (2016) · Pilot and Feasibility Studies · doi:10.1186/s40814-016-0067-x · Cited by 147
Self-citationChanging Behavior Using the Model of Action Phases
Keller, L., Gollwitzer, P. M., & Sheeran, P. (2020) · The Handbook of Behavior Change · doi:10.1017/9781108677318.006 · Cited by 147
Wong, E., Mavondo, F., & Fisher, J. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05383-3 · Cited by 189
“This is further supported by findings from studies [58, 59] investigating factors needed for successful implementation and integration of interventions to routine work using the Normalisation Process Theory [60, 61].”
Ross, J., Stevenson, F. A., Dack, C., Pal, K., May, C. R., Michie, S., Barnard, M., & Murray, E. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3615-7 · Cited by 142
“Normalization Process Theory (NPT) [36, 37] was selected to guide the development of the implementation plan.”
MethodSelf-citationSexual health promotion for young people delivered via digital media: a scoping review
Bailey, J., Mann, S., Wayal, S., Hunter, R. M., Free, C., Abraham, C., & Murray, E. (2015) · Public Health Research · doi:10.3310/phr03130 · Cited by 144
Self-citationFinch, T. L., Mair, F. S., O’Donnell, C., Murray, E., & May, C. R. (2012) · BMC Medical Research Methodology · doi:10.1186/1471-2288-12-69 · Cited by 127
“The development of NPT [37] focused on addressing two key criteria for theory to be ‘useful’: that it must be both adequately described and fit for purpose.”
Self-citationThe Strategic Action Field Framework for Policy Implementation Research
Moulton, S., & Sandfort, J. R. (2016) · Policy Studies Journal · doi:10.1111/psj.12147 · Cited by 139
“This is the primary focus of implementation science research; exploring the factors that lead to the successful integration of new evidence-based interventions into standard operating procedures (Damschroder et al., 2009; Durlak & DuPre, 2008; May 2013; May et al., 2009).”
BackgroundCôté-Boileau, É., Denis, J.-L., Callery, B., & Sabean, M. (2019) · Health Research Policy and Systems · doi:10.1186/s12961-019-0482-6 · Cited by 133
“In terms of jurisdiction, Table 1 Description of themes included in the thematic analysis Theme Description Definitions Statement of the meaning of a word or concept Mechanisms Coherence, cognitive participation, collective action, reflexive monitoring through which human agency is expressed [61] Support conditions In…”
BackgroundImplementation of safety checklists in surgery: a realist synthesis of evidence
Gillespie, B. M., & Marshall, A. (2015) · Implementation Science · doi:10.1186/s13012-015-0319-9 · Cited by 130
“The four components of NPT include the following: coherence (sense-making), cognitive participation (engagement), collective action (actions that enable the intervention to be implemented), and reflexive monitoring (formal and informal assessment of the benefits and costs of the intervention) [25, 27].”
BackgroundKeyworth, C., Epton, T., Goldthorpe, J., Calam, R. M., & Armitage, C. J. (2019) · British Journal of Health Psychology · doi:10.1111/bjhp.12368 · Cited by 142
Implementing AI in healthcare—the relevance of trust: a scoping review
Steerling, E., Siira, E., Nilsén, P., Svedberg, P., & Nygren, J. (2023) · Frontiers in Health Services · doi:10.3389/frhs.2023.1211150 · Cited by 152
Birken, S. A., Haines, E. R., Hwang, S., Chambers, D., Bunger, A. C., & Nilsén, P. (2020) · Implementation Science · doi:10.1186/s13012-020-01040-9 · Cited by 124
Spelten, E. R., Thomas, B., O'Meara, P. F., Maguire, B. J., FitzGerald, D., & Begg, S. J. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012662.pub2 · Cited by 121
Jacob, C., Sánchez-Vázquez, A., & Ivory, C. J. (2020) · JMIR mhealth and uhealth · doi:10.2196/18072 · Cited by 120
“Bagot et al [15] employed the NPT [108,109], as it suggests a nonlinear understanding of adoption, taking into account the interdependent connections within an organizational context.”
MethodTheories Informing eHealth Implementation: Systematic Review and Typology Classification
Heinsch, M., Wyllie, J., Carlson, J., Wells, H., Tickner, C., & Kay-Lambkin, F. (2021) · Journal of Medical Internet Research · doi:10.2196/18500 · Cited by 114
“Of these, the normalization process theory (NPT) by May et al [80] occurred most frequently in the literature (17 instances), followed by structuration theory (ST) [81] (6 instances) and actor-network theory (ANT) [82,83] (4 instances).”
BackgroundAriëns, L. F. M., Schussler-Raymakers, F. M., Frima, C., Flinterman, A. E., Hamminga, E. A., Arents, B. W. M., Bruijnzeel-Koomen, C. A. F. M., de Bruin-Weller, M. S., & van Os‐Medendorp, H. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7512 · Cited by 117
Petersen, I., van Rensburg, A., Kigozi, F., Semrau, M., Hanlon, C., Abdulmalik, J., Kola, L., Fekadu, A., Gureje, O., Gurung, D., et al. (2019) · BJPsych Open · doi:10.1192/bjo.2019.7 · Cited by 111
Changing Behavior Using the Health Action Process Approach
Schwarzer, R., & Hamilton, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.007 · Cited by 114
Implementing a stepped-care approach in primary care: results of a qualitative study
Franx, G., Oud, M., de Lange, J., Wensing, M., & Grol, R. (2012) · Implementation Science · doi:10.1186/1748-5908-7-8 · Cited by 106
“According to NPT, there are four mechanisms that drive change: coherence, cognitive participation, collective action, and reflexive monitoring [19]http://normalizationprocess.”
BackgroundMethodInfluentialBrowne, S. E., Macdonald, S., May, C. R., Macleod, U., & Mair, F. S. (2014) · PLoS ONE · doi:10.1371/journal.pone.0093288 · Cited by 102
Self-citationPope, C., Halford, S., Turnbull, J., Prichard, J., Calestani, M., & May, C. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-111 · Cited by 101
“work of normalisation and the practices of embedding [48].”
BackgroundSelf-citationKeyworth, C., Epton, T., Goldthorpe, J., Calam, R. M., & Armitage, C. J. (2018) · Implementation Science · doi:10.1186/s13012-018-0814-x · Cited by 101
“May CR, Mair F, Finch T, et al. Development of a theory of implementation and integration: Normalization Process Theory.”
BackgroundStewart, D. C., & Klein, S. (2015) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-015-0216-y · Cited by 99
“bringing practices into action; embedding—the process through which practices become incorporated routinely into everyday work; and integration—the process by which practices are reproduced and sustained [14, 15].”
BackgroundYao, X., McCoy, R. G., Friedman, P. A., Shah, N. D., Barry, B. A., Behnken, E. M., Inselman, J. W., Attia, Z. I., & Noseworthy, P. A. (2020) · American Heart Journal · doi:10.1016/j.ahj.2019.10.007 · Cited by 98
Flynn, R., Rotter, T., Hartfield, D. S., Newton, A. S., & Scott, S. D. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4744-3 · Cited by 103
Health Behavior Change for Obesity Management
Teixeira, P. J., & Marques, M. M. (2017) · Obesity Facts · doi:10.1159/000484933 · Cited by 97
Potthoff, S., Finch, T. L., Bührmann, L., Etzelmüller, A., van Genugten, C., Girling, M., May, C. R., Perkins, N., Vis, C., & Rapley, T. (2023) · Health Expectations · doi:10.1111/hex.13808 · Cited by 114
“Interviews with ILs, core team members and stakeholders within implementation sites were conducted repeatedly throughout the trial period using a theory‐informed topic guide that evolved over time.(35) Core team members and stakeholders were sampled and interviewed to gain in‐depth data on specific issues, and develop…”
MethodSelf-citationSvendsen, M. J., Wood, K., Kyle, J., Cooper, K., Rasmussen, C. D. N., Sandal, L. F., Stochkendahl, M. J., Mair, F. S., & Nicholl, B. I. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-038800 · Cited by 99
“37 Three interventions offered time limited programmes of either 5 weeks 36 37 or 8 weeks, 38 while the fourth intervention was an open- to-access website with no time restrictions 27 28 (table 4).”
Self-citationComplexity and the science of implementation in health IT—Knowledge gaps and future visions
Abbott, P. A., Foster, J., Marin, H. D. F., & Dykes, P. C. (2014) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2013.10.009 · Cited by 95
Leeman, J., Calancie, L., Kegler, M. C., Escoffery, C. T., Herrmann, A. K., Thatcher, E., Hartman, M. A., & Fernandez, M. E. (2017) · Health Education & Behavior · doi:10.1177/1090198115610572 · Cited by 90
“When task complexity is higher as opposed to lower, support systems may explore marketing EBIs in formats that maximize their adaptability and triability (Atun et al., 2010; May et al., 2009).”
Bales, D. L., Timman, R., Luyten, P., Busschbach, J. J. V., Verheul, R., & Hutsebaut, J. (2017) · Personality and Mental Health · doi:10.1002/pmh.1381 · Cited by 95
May, C. R., Sibley, A., & Hunt, K. J. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2013.06.019 · Cited by 90
“The second iteration of the theory (May and Finch, 2009; May et al., 2009), built on the analysis of Collective Action, and showed how this was linked to the mechanisms through which people make their activities meaningful and build commitments to them.”
BackgroundMethodSelf-citationRowley, E., Morriss, R. K., Currie, G., & Schneider, J. M. (2012) · Implementation Science · doi:10.1186/1748-5908-7-40 · Cited by 97
“Abbreviations ADHD: Attention deficit hyperactivity disorder; CAMHs: Child and adolescent mental health; CLAHRC: Collaboration for Leadership in Applied Health Research and Care; CoPs: Communities of practice; DF: Diffusion fellow; KTA: Knowledge to action; MRC: Medical Research Council; NDL: Nottinghamshire, Derbyshi…”
BackgroundMethodInfluentialDevlin, A. M., Lennon, M., O’Donnell, C. A., Bouamrane, M.-M., Agbakoba, R., O’Connor, S., Grieve, E., Finch, T. L., Wyke, S., Watson, N., et al. (2015) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv097 · Cited by 97
“Our evaluation adopts a socio-technical approach, 16–19 using a mixed methods evaluation framework consistent with evaluations of complex interventions.”
Self-citationGallacher, K., Jani, B., Morrison, D., Macdonald, S., Blane, D., Erwin, P. J., May, C. R., Montori, V. M., Eton, D. T., Smith, F., et al. (2013) · BMC Medical Research Methodology · doi:10.1186/1471-2288-13-10 · Cited by 90
“It has been suggested that Normalization Process Theory (NPT) [43,44] could potentially offer new ways to approach the analysis of qualitative data gathered as part of a systematic review and that it could have a role in helping to interpret data when considering how patients or carers manage/deal with a range of cond…”
Self-citationVis, C., Ruwaard, J., Finch, T. L., Rapley, T., Beurs, D. P. D., van Stel, H. F., van Lettow, B., Mol, M., Kleiboer, A. M., Riper, H. M., et al. (2019) · Journal of Medical Internet Research · doi:10.2196/12376 · Cited by 85
Self-citation
Metadata
- 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
- Published
- 2009-05-21
- Volume
- 4
- Issue
- 1
- Pages
- 29-29
- ISSN
- 1748-5908 (ISSN-L)
- 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
- gold
- doi.org
- 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 › Business, Management and Accounting › Management Information Systems › 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.
A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-06 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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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