From theory to practice: using the Normalization Process Theory and Theoretical Domains Framework to understand...

Area of Science:

• Healthcare Sustainability
• General Practice
• Environmental Policy

Background:

• Decarbonization is crucial for a net-zero healthcare system.
• Understanding facilitators and barriers to sustainable practices in general practice is essential.
• This study aims to advance knowledge on factors influencing decarbonization in general practice.

Purpose of the Study:

• To map and compare the application of the Normalization Process Theory (NPT) and Theoretical Domains Framework (TDF).
• To understand key factors and sub-factors related to decarbonization in general practice using NPT and TDF.

Main Methods:

• A multidisciplinary team of 10 coders independently mapped factors from a systematic review to NPT constructs and TDF domains.
• Factors were derived from systematic review and narrative synthesis.
• Coder agreement was evaluated for consistency and reliability.

Main Results:

• Key NPT domains ('Coherence', 'Collective Action', 'Cognitive Participation') and TDF domains ('Environmental Context and Resources', 'Knowledge', 'Social/professional role and identity') were identified.
• High intercoder reliability (73% for NPT, 84% for TDF) supports the analysis consistency.
• Structured drivers like financial incentives and policy support were particularly well-supported.

Conclusions:

• NPT and TDF frameworks offer valuable, albeit incomplete, insights into factors affecting general practice decarbonization.
• These factors warrant greater attention in developing evidence-based decarbonization strategies.
• Future research should evaluate the application of these frameworks in promoting decarbonization.