Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare...

Area of Science:

• Healthcare Implementation Science
• Health Services Research
• Intervention Science

Background:

• Normalization Process Theory (NPT) is a framework for understanding the implementation, embedding, and integration of complex healthcare interventions.
• A significant body of literature now utilizes NPT for feasibility studies and process evaluations of healthcare interventions.

Purpose of the Study:

• To systematically review the literature employing NPT in healthcare intervention research.
• To identify and characterize the applications and limitations of NPT in implementation and integration studies.
• To explore NPT's contribution to understanding the dynamics of healthcare implementation processes.

Main Methods:

• A qualitative systematic review was conducted.
• Searches included Web of Science, Scopus, and Google Scholar for peer-reviewed articles citing key NPT papers or the NPT Online Toolkit.
• Inclusion criteria required NPT to be the primary approach for data collection, analysis, or reporting in studies of healthcare intervention implementation.

Main Results:

• 130 papers from 108 studies were included after screening 3322 citations.
• NPT provides a conceptual vocabulary for rigorous implementation studies, identifying mechanisms that shape these processes.
• Analyses using NPT effectively explain the success or failure of implementation projects, though some critiques focused on terminology, agency, and normative aspects.

Conclusions:

• Researchers find NPT useful across diverse interventions, aiding development, planning, evaluation, and understanding of implementation.
• NPT offers valuable conceptual tools for understanding implementation as a dynamic process.
• The theory effectively supports rigorous research into the practical application of healthcare interventions.