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Using normalization process theory in feasibility studies and process evaluations of complex healthcare interventions: A systematic review

Using normalization process theory in feasibility studies and process evaluations of complex healthcare interventions: A systematic review
Using normalization process theory in feasibility studies and process evaluations of complex healthcare interventions: A systematic review
Background
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. A large body of literature that employs NPT to inform feasibility studies and process evaluations of complex healthcare interventions has now emerged. The aims of this review were to review this literature; to identify and characterise the uses and limits of NPT in research on the implementation and integration of healthcare interventions; and to explore NPT’s contribution to understanding the dynamics of these processes.

Methods
A qualitative systematic review was conducted. We searched Web of Science, Scopus and Google Scholar for articles with empirical data in peer-reviewed journals that cited either key papers presenting and developing NPT, or the NPT Online Toolkit (www.normalizationprocess.org). We included in the review only articles that used NPT as the primary approach to collection, analysis or reporting of data in studies of the implementation of healthcare techniques, technologies or other interventions. A structured data extraction instrument was used, and data were analysed qualitatively.

Results
Searches revealed 3322 citations. We show that after eliminating 2337 duplicates and broken or junk URLs, 985 were screened as titles and abstracts. Of these, 101 were excluded because they did not fit the inclusion criteria for the review. This left 884 articles for full-text screening. Of these, 754 did not fit the inclusion criteria for the review. This left 130 papers presenting results from 108 identifiable studies to be included in the review. NPT appears to provide researchers and practitioners with a conceptual vocabulary for rigorous studies of implementation processes. It identifies, characterises and explains empirically identifiable mechanisms that motivate and shape implementation processes. Taken together, these mean that analyses using NPT can effectively assist in the explanation of the success or failure of specific implementation projects. Ten percent of papers included critiques of some aspect of NPT, with those that did mainly focusing on its terminology. However, two studies critiqued NPT emphasis on agency, and one study critiqued NPT for its normative focus.

Conclusions
This review demonstrates that researchers found NPT useful and applied it across a wide range of interventions. It has been effectively used to aid intervention development and implementation planning as well as evaluating and understanding implementation processes themselves. In particular, NPT appears to have offered a valuable set of conceptual tools to aid understanding of implementation as a dynamic process.
May, Carl
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Cummings, Amanda
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Girling, Melissa
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Bracher, Michael
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Mair, Frances S.
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May, Christine M.
227ab47a-1ca0-4437-905a-bd90feacc3d5
Murray, Elizabeth
cb300780-9041-44af-9ae5-e13531eb23b8
Myall, Michelle
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Rapley, Tim
eb4364d5-c016-403a-969a-aae1fd35a97c
Finch, Tracy
b1916307-8516-4b70-8ba5-05d3310839de
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Cummings, Amanda
7c5f6bd2-979b-456d-9368-8edd13c06691
Girling, Melissa
de8d65de-460b-4767-903c-8e8571f1fe5c
Bracher, Michael
e9e2fbd6-af5f-4f6e-8357-969aaf51c52e
Mair, Frances S.
303709c7-028a-44b9-b6da-e14f2d834f2b
May, Christine M.
227ab47a-1ca0-4437-905a-bd90feacc3d5
Murray, Elizabeth
cb300780-9041-44af-9ae5-e13531eb23b8
Myall, Michelle
0604ba0f-75c2-4783-9afe-aa54bf81513f
Rapley, Tim
eb4364d5-c016-403a-969a-aae1fd35a97c
Finch, Tracy
b1916307-8516-4b70-8ba5-05d3310839de

May, Carl, Cummings, Amanda, Girling, Melissa, Bracher, Michael, Mair, Frances S., May, Christine M., Murray, Elizabeth, Myall, Michelle, Rapley, Tim and Finch, Tracy (2018) Using normalization process theory in feasibility studies and process evaluations of complex healthcare interventions: A systematic review. Implementation Science, 13, [80]. (doi:10.1186/s13012-018-0758-1).

Record type: Article

Abstract

Background
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. A large body of literature that employs NPT to inform feasibility studies and process evaluations of complex healthcare interventions has now emerged. The aims of this review were to review this literature; to identify and characterise the uses and limits of NPT in research on the implementation and integration of healthcare interventions; and to explore NPT’s contribution to understanding the dynamics of these processes.

Methods
A qualitative systematic review was conducted. We searched Web of Science, Scopus and Google Scholar for articles with empirical data in peer-reviewed journals that cited either key papers presenting and developing NPT, or the NPT Online Toolkit (www.normalizationprocess.org). We included in the review only articles that used NPT as the primary approach to collection, analysis or reporting of data in studies of the implementation of healthcare techniques, technologies or other interventions. A structured data extraction instrument was used, and data were analysed qualitatively.

Results
Searches revealed 3322 citations. We show that after eliminating 2337 duplicates and broken or junk URLs, 985 were screened as titles and abstracts. Of these, 101 were excluded because they did not fit the inclusion criteria for the review. This left 884 articles for full-text screening. Of these, 754 did not fit the inclusion criteria for the review. This left 130 papers presenting results from 108 identifiable studies to be included in the review. NPT appears to provide researchers and practitioners with a conceptual vocabulary for rigorous studies of implementation processes. It identifies, characterises and explains empirically identifiable mechanisms that motivate and shape implementation processes. Taken together, these mean that analyses using NPT can effectively assist in the explanation of the success or failure of specific implementation projects. Ten percent of papers included critiques of some aspect of NPT, with those that did mainly focusing on its terminology. However, two studies critiqued NPT emphasis on agency, and one study critiqued NPT for its normative focus.

Conclusions
This review demonstrates that researchers found NPT useful and applied it across a wide range of interventions. It has been effectively used to aid intervention development and implementation planning as well as evaluating and understanding implementation processes themselves. In particular, NPT appears to have offered a valuable set of conceptual tools to aid understanding of implementation as a dynamic process.

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More information

Accepted/In Press date: 24 April 2018
e-pub ahead of print date: 7 June 2018
Published date: 7 June 2018

Identifiers

Local EPrints ID: 424766
URI: http://eprints.soton.ac.uk/id/eprint/424766
PURE UUID: 10b06bc5-4125-41aa-8935-8cd6a96490a6
ORCID for Carl May: ORCID iD orcid.org/0000-0002-0451-2690
ORCID for Michael Bracher: ORCID iD orcid.org/0000-0001-5861-2657
ORCID for Michelle Myall: ORCID iD orcid.org/0000-0001-8733-7412

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Date deposited: 05 Oct 2018 11:45
Last modified: 18 Feb 2021 17:15

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