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A qualitative systematic review of studies using the normalization process theory to research implementation

Rachel McEvoy1, Luciana Ballini, Susanna Maltoni

  • 1Graduate Entry Medical School, 4i Research Center, University of Limerick, Limerick, Ireland. rachel.mcevoy@hse.ie.

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Normalization Process Theory (NPT) is a sociological framework that helps understand how new practices are implemented in healthcare. This review shows NPT is a valuable tool for analyzing complex interventions and guiding implementation processes.

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Area of Science:

  • Sociology
  • Healthcare Management
  • Implementation Science

Background:

  • A recognized need exists to bridge research translational gaps using theoretical frameworks.
  • Normalization Process Theory (NPT) offers sociological tools to understand implementation processes in healthcare and other organizations.
  • This review examines the application and benefits of NPT in analyzing interventions.

Purpose of the Study:

  • To review the literature on Normalization Process Theory (NPT).
  • To understand what interventions NPT analyzes.
  • To determine how NPT is operationalized and its reported benefits.

Main Methods:

  • A qualitative systematic review using a framework analysis approach.
  • Searched 12 electronic databases and citations of key NPT papers.
  • Included English language, healthcare setting studies published from 2006 to June 2012.

Main Results:

  • Twenty-nine articles met inclusion criteria, applying NPT to diverse complex interventions beyond e-health.
  • NPT constructs demonstrated high stability across different settings.
  • NPT serves as a beneficial heuristic device for explaining and guiding implementation, despite some construct overlap challenges.

Conclusions:

  • NPT provides a generalizable framework applicable across contexts, facilitating incremental knowledge gain.
  • NPT offers an explicit analytical framework that can explain and shape implementation processes.
  • This review, the first of NPT in use, encourages further application and recommends explicating rationale and involving stakeholders in future research.