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

May, Carl; Finch, Tracy; Mair, Frances; Ballini, Luciana; Dowrick, Christopher; Eccles, Martin; Gask, Linda; MacFarlane, Anne; Murray, Elizabeth; Rapley, Tim; Rogers, Anne; Treweek, Shaun; Wallace, Paul; Anderson, George; Burns, Jo and Heaven, Ben (2007) Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Services Research, 7 . Article Number: 148. ISSN 1472-6963

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Abstract

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

Item Type:Article
Additional Information:7 pages (page numbers not for citation purposes). Published: 19 September 2007.
Uncontrolled Keywords:IMPROVE HEALTH; DIFFUSION; BEHAVIOR
Subjects:R Medicine > R Medicine (General)
Departments, Research Centres and Related Units:Academic Faculties, Institutes and Research Centres > Faculty of Medicine > School of Population, Community & Behavioural Sciences
DOI:10.1186/1472-6963-7-148
Publisher's Statement:© 2007 May et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Related URLs:
Refereed:Yes
Status:Published
ID Code:680
Deposited On:06 Jun 2008 14:43
Last Modified:20 May 2011 09:01

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