scholarly journals Evaluating Implementation Contexts, Mechanisms, and Outcomes: A Normalization Process Theory Coding Manual for Qualitative Research and Instrument Development

2021 ◽  
Author(s):  
Carl May ◽  
Bianca Albers ◽  
Mike Bracher ◽  
Tracy L Finch ◽  
Anthony Gilbert ◽  
...  
Keyword(s):  
Qualitative Content Analysis ◽  
Evaluation Research ◽  
Realist Evaluation ◽  
Normalization Process Theory ◽  
Process Theory ◽  
Theoretical Concepts ◽  
Robust Coding ◽  
Implementation Studies ◽  
Coding Manual ◽  
Normalization Process

Abstract Background. Qualitative studies, especially those conducted by teams of researchers, may benefit from clearly structured, parsimonious, coding manuals. The process of creating rigorous and robust coding manuals for individual studies is rarely described, and generalizable coding manuals are rare. Normalization Process Theory (NPT) provides conceptual tools to facilitate understanding of the dynamics of adoption, implementation, and sustainment of socio-technical and organizational innovations. As a widely used theory, a generalizable coding manual would be of utility to implementation researchersObjectives. To make the application of NPT simple for the user, to describe the development of a coding manual for qualitative content analytic studies using NPT, and present this for wider use.Method. Concept Selection and Structuring. Qualitative Content Analysis of selected published papers and interview transcripts. Results. All identifiable theoretical concepts (n=149) embedded in papers and chapters that developed NPT between 2006 and 2020 were identified and extracted from their texts. Overlapping, ambiguous, and duplicate versions of concepts were eliminated, as were concepts derived from other theories. This left 38 core concept definitions. These were piloted in coding of qualitative transcripts collected in two implementation studies, and by collaboratively coding papers collected for a systematic review of implementation studies. At the end of this process, a further process of elimination of overlapping or ambiguous concepts was undertaken leaving 12 primary NPT concepts. Conclusion. The process of coding manual resulted in the presentation of NPT concepts according to the Context-Mechanism-Outcomes configuration of realist evaluation research. A coding manual for NPT that is in accordance with realistic evaluation research was successfully produced and is now freely available to researchers who wish to use NPT in primary and secondary research that employs qualitative methods.

scholarly journals Combining Realist approaches and Normalization Process Theory to understand implementation: a systematic review

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Sonia Michelle Dalkin ◽  
Rebecca J. L. Hardwick ◽  
Catherine A. Haighton ◽  
Tracy L. Finch
Keyword(s):  
Systematic Review ◽  
Health Management ◽  
Explanatory Power ◽  
Family Health ◽  
Realist Evaluation ◽  
Normalization Process Theory ◽  
Process Theory ◽  
Scientific Realist ◽  
Health Database ◽  
Normalization Process

Abstract Background Realist approaches and Normalization Process Theory (NPT) have both gained significant traction in implementation research over the past 10 years. The aim of this study was therefore to explore how the approaches are combined to understand problems of implementation, to determine the degree of complementarity of the two approaches and to provide practical approaches for using them together. Methods Systematic review of research studies combining Realist and NPT approaches. Realist methodology is concerned with understanding and explaining causation, that is, how and why policies, programmes and interventions achieve their effects. NPT is a theory of implementation that explains how practices become normalised. Databases searched (January 2020) were ASSIA, CINAHL, Health Research Premium Collection via Proquest (Family Health Database, Health & Medical Collection, Health Management Database, MEDLINE, Nursing & Allied Health Database, Psychology Database, Public Health Database) and PsycARTICLES. Studies were included if the author(s) stated they used both approaches: a scientific Realist perspective applying the principles of Pawson and Tilley’s Realist Evaluation or Pawson’s Realist Synthesis and Normalization Process Theory either solely or in addition to other theories. Two authors screened records; discrepancies were reviewed by a third screener. Data was extracted by three members of the team and a narrative synthesis was undertaken. Results Of 245 total records identified, 223 unique records were screened and 39 full-text papers were reviewed, identifying twelve papers for inclusion in the review. These papers represented eight different studies. Extent and methods of integration of the approaches varied. In most studies (6/8), Realist approaches were the main driver. NPT was mostly used to enhance the explanatory power of Realist analyses, informing development of elements of Contexts, Mechanisms and Outcomes (a common heuristic in realist work). Authors’ reflections on the integration of NPT and Realist approaches were limited. Conclusions Using Realist and NPT approaches in combination can add explanatory power for understanding the implementation of interventions and programmes. Attention to detailed reporting on methods and analytical process when combining approaches, and appraisal of theoretical and practical utility is advised for advancing knowledge of applying these approaches in research. Systematic review registration Not registered.

Using Normalization Process Theory to Evaluate the Implementation of Montessori-based Volunteer Visits Within a Canadian Long-term Care Home

2018 ◽  
Author(s):  
Paulette V Hunter ◽  
Lilian Thorpe ◽  
Celine Hounjet ◽  
Thomas Hadjistavropoulos
Keyword(s):  
Long Term Care ◽  
Qualitative Content Analysis ◽  
Care Home ◽  
Dementia Care ◽  
Normalization Process Theory ◽  
Process Theory ◽  
Term Care ◽  
Staff Members ◽  
Normalization Process

Abstract Background and Objectives Montessori-based interventions (MBIs) have potential to improve the life quality of long-term care residents with dementia. In this study, we aimed to understand the processes by which staff integrated a volunteer-led MBI into practice within a special dementia care unit, and to explore staff members ’ perceptions of associated strengths and limitations. Research Design and Methods This study relied on a qualitative descriptive design. Following a 3-month period of volunteer involvement, we conducted 21 interviews with staff members to document perceptions of the new program and subjected interview transcripts to qualitative content analysis, guided by normalization process theory. Results During the implementation of the volunteer-led MBI, staff members developed a shared understanding of the intervention, a sense of commitment, practical ways to support the intervention, and opinions about the value of the residents. Overall, we found that the volunteer-led MBI was quickly and successfully integrated into practice and was perceived to support both residents and staff members in meaningful ways. Nevertheless, some limitations were also identified. Discussion and Implications Volunteer-delivered MBIs are a useful adjunct to practice within a special dementia care unit. This article raises attention to some strengths and limitations associated with this approach.

scholarly journals The Swedish version of the Normalization Process Theory Measure S-NoMAD: translation, adaptation, and pilot testing

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Marie Elf ◽  
Sofi Nordmark ◽  
Johan Lyhagen ◽  
Inger Lindberg ◽  
Tracy Finch ◽  
...  
Keyword(s):  
Normalization Process Theory ◽  
Process Theory ◽  
Swedish Version ◽  
Pilot Testing ◽  
Normalization Process

scholarly journals Impact of a health literacy intervention combining general practitioner training and a consumer facing intervention to improve colorectal cancer screening in underserved areas: protocol for a multicentric cluster randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie-Anne Durand ◽  
Aurore Lamouroux ◽  
Niamh M. Redmond ◽  
Michel Rotily ◽  
Aurélie Bourmaud ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Literacy ◽  
Normalization Process Theory ◽  
Trial Registration ◽  
Process Theory ◽  
Crc Screening ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
The Impact ◽  
Normalization Process

Abstract Background Colorectal cancer (CRC) is a leading cause of cancer burden worldwide. In France, it is the second most common cause of cancer death after lung cancer. Systematic uptake of CRC screening can improve survival rates. However, people with limited health literacy (HL) and lower socioeconomic position rarely participate. Our aim is to assess the impact of an intervention combining HL and CRC screening training for general practitioners (GPs) with a pictorial brochure and video targeting eligible patients, to increase CRC screening and other secondary outcomes, after 1 year, in several underserved geographic areas in France. Methods We will use a two-arm multicentric randomized controlled cluster trial with 32 GPs primarily serving underserved populations across four regions in France with 1024 patients recruited. GPs practicing in underserved areas (identified using the European Deprivation Index) will be block-randomized to: 1) a combined intervention (HL and CRC training + brochure and video for eligible patients), or 2) usual care. Patients will be included if they are between 50 and 74 years old, eligible for CRC screening, and present to recruited GPs. The primary outcome is CRC screening uptake after 1 year. Secondary outcomes include increasing knowledge and patient activation. After trial recruitment, we will conduct semi-structured interviews with up to 24 GPs (up to 8 in each region) and up to 48 patients (6 to 12 per region) based on data saturation. We will explore strategies that promote the intervention’s sustained use and rapid implementation using Normalization Process Theory. We will follow a community-based participatory research approach throughout the trial. For the analyses, we will adopt a regression framework for all quantitative data. We will also use exploratory mediation analyses. We will analyze all qualitative data using a framework analysis guided by Normalization Process Theory. Discussion Limited HL and its impact on the general population is a growing public health and policy challenge worldwide. It has received limited attention in France. A combined HL intervention could reduce disparities in CRC screening, increase screening rates among the most vulnerable populations, and increase knowledge and activation (beneficial in the context of repeated screening). Trial registration Registry: ClinicalTrials.gov. Trial registration number: 2020-A01687-32. Date of registration: 17th November 2020.

scholarly journals Cognitive stimulation therapy in dementia care: exploring the views and experiences of service providers on the barriers and facilitators to implementation in practice using Normalization Process Theory

2017 ◽  
Vol 29 (11) ◽  
pp. 1869-1878 ◽  
Author(s):  
Claire Dickinson ◽  
Grant Gibson ◽  
Zoe Gotts ◽  
Lynne Stobbart ◽  
Louise Robinson
Keyword(s):  
Psychosocial Intervention ◽  
Cost Effective ◽  
Dementia Care ◽  
Normalization Process Theory ◽  
Cognitive Stimulation ◽  
Process Theory ◽  
Evidence Based ◽  
Cognitive Stimulation Therapy ◽  
People With Dementia ◽  
Normalization Process

ABSTRACTBackground:Cognitive stimulation therapy (CST) is an evidence-based, cost-effective psychosocial intervention for people with dementia but is currently not a standard part of post-diagnostic care. This qualitative study explored the views and experiences of dementia care providers on the barriers and facilitators to its implementation in usual care.Method:Thirty four semi-structured interviews (24 participants) were conducted across four dementia care sites in the North of England; ten were follow-up interviews. Data were analyzed using thematic analysis and then mapped to the Normalization Process Theory framework.Results:Participants considered CST a “good fit” with their “preferred” ways of working and goals of dementia care namely the provision of person-centered services. For facilitators delivering the intervention, compared to other behavioral interventions, CST was seen to offer benefits to their work and was easy to understand as an intervention. Training in CST and seeing benefits for clients were important motivators. Time and resources were crucial for the successful implementation of CST. Participants were keen to objectively measure benefits to participants but unsure how to do this.Conclusions:CST is a cost-effective psychosocial intervention for people with dementia, recommended by national guidance. Despite our findings which show that, using the NPT framework, there are more facilitators than barriers to the implementation of CST, it is still not a standard part of post-diagnostic dementia care. Further research is needed to explore the reasons for this implementation gap in ensuring evidence-based care in translated into practice.

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