Abstract
BackgroundThere is a well-recognized need for greater use of theory to address research translational gaps. Normalization Process Theory (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 implemented, embedded, and integrated in healthcare and other organizational settings. This review of NPT offers readers the opportunity to observe how, and in what areas, a particular theoretical approach to implementation is being used. In this article we review the literature on NPT in order to understand what interventions NPT is being used to analyze, how NPT is being operationalized, and the reported benefits, if any, of using NPT.MethodsUsing a framework analysis approach, we conducted a qualitative systematic review of peer-reviewed literature using NPT. We searched 12 electronic databases and all citations linked to six key NPT development papers. Grey literature/unpublished studies were not sought. Limitations of English language, healthcare setting and year of publication 2006 to June 2012 were set.ResultsTwenty-nine articles met the inclusion criteria; in the main, NPT is being applied to qualitatively analyze a diverse range of complex interventions, many beyond its original field of e-health and telehealth. The NPT constructs have high stability across settings and, notwithstanding challenges in applying NPT in terms of managing overlaps between constructs, there is evidence that it is a beneficial heuristic device to explain and guide implementation processes.ConclusionsNPT offers a generalizable framework that can be applied across contexts with opportunities for incremental knowledge gain over time and an explicit framework for analysis, which can explain and potentially shape implementation processes. This is the first review of NPT in use and it generates an impetus for further and extended use of NPT. We recommend that in future NPT research, authors should explicate their rationale for choosing NPT as their theoretical framework and, where possible, involve multiple stakeholders including service users to enable analysis of implementation from a range of perspectives.
Highlights
There is a well-recognized need for greater use of theory to address research translational gaps
This paper describes the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions, and identifies key issues and methodological challenges for advancing work in this field
Of the 20 papers that provided data about their experiences of using Normalization Process Theory (NPT), 15 [5,18,19,28,35,37,38,39,43,46,47,49,50,51,52] commented that NPT was beneficial because it provided an explanatory theoretical framework for helping to identify factors that promote and inhibit implementation of complex interventions: ‘Our findings suggest that NPT provides a useful framework for understanding the processes that affect the implementation, embedding, and integration of new technologies into healthcare systems’ [18]
Summary
There is a well-recognized need for greater use of theory to address research translational gaps. In this article we review the literature on NPT in order to understand what interventions NPT is being used to analyze, how NPT is being operationalized, and the reported benefits, if any, of using NPT. In spite of the growth in literature, there remains a well-recognized and significant translational gap between these domains. This gap has captured the attention of policy makers and researchers alike, with repeated calls for the greater use of explicit theory in research that explores implementation processes [2,3,4]. It is important both to develop and test new theories that are in use, to appraise their relevance and utility for the field of implementation research [8,9,10]
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