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BioMed Central, BMC Health Services Research, 1(7), 2007

DOI: 10.1186/1472-6963-7-148

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

Journal article published in 2007 by Carl Finch T. Mair F. Ballini L. Dowrick C. Eccles M. Gask LL Macfarlane A. Murray E. Rapley T. Rogers AE Treweek S. Wallace P. Anderson G. Burns J. Heaven B. May, Tracy Finch ORCID, Frances Mair ORCID, Luciana Ballini, Christopher Dowrick, Martin Eccles, Linda Gask, Anne MacFarlane ORCID, Elizabeth Murray ORCID, Tim Rapley, Anne Rogers, Shaun Treweek, Paul Wallace, A. MacFalane, George Anderson and other authors.
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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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 the process evaluation of complex interventions, 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. METHOD: 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: social processes involving (a) interactions between people (in collective action) and technologies (complex interventions and others); and (b) the endogenous qualities of those interactions (interactional workability and relational integration), and their exogenous properties (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.