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Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: A systematic review

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journal contribution
posted on 22.05.2020 by L Huddlestone, J Turner, H Eborall, N Hudson, M Davies, G Martin
Background: Normalisation Process Theory (NPT) provides a framework to understand how interventions are implemented, embedded, and integrated in healthcare settings. Previous reviews of published literature have examined the application of NPT across international healthcare and reports its benefits. However, given the distinctive clinical function, organisational arrangements and the increasing management of people with a wide variety of conditions in primary care settings in the United Kingdom, it is important to understand how and why authors utilise and reflect on NPT in such settings to inform and evaluate implementation processes. Methods: A systematic review of peer-reviewed literature using NPT in primary care settings in the United Kingdom (UK) was conducted. Eight electronic databases were searched using replicable methods to identify articles published between January 2012 and April 2018. Data were analysed using a framework approach. Results: Thirty-one articles met the inclusion criteria. Researchers utilised NPT to explore the implementation of interventions, targeting a wide range of health services and conditions, within primary care settings in the UK. NPT was mostly applied qualitatively; however, a small number of researchers have moved towards mixed and quantitative methods. Some variation was observed in the use of NPT constructs and sub-constructs, and whether and how researchers undertook modification to make them more relevant to the implementation process and multiple stakeholder perspectives. Conclusion: NPT provides a flexible framework for the development and evaluation of complex healthcare interventions in UK primary care settings. This review updates the literature on NPT use and indicates that its application is well suited to these environments, particularly in supporting patients with long-term conditions and co-morbidities. We recommend future research explores the receipt of interventions by multiple stakeholders and suggest that authors reflect on justifications for using NPT in their reporting.

Funding

This study/project is funded by the National Institute for Health Research (NIHR) [Programme Grants for Applied Research (Increasing uptake of effective self-management education programmes for type 2 diabetes in multi-ethnic primary care settings. Project reference: RP-PG-1212-20004)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

History

Citation

Huddlestone, L., Turner, J., Eborall, H. et al. Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review. BMC Fam Pract 21, 52 (2020). https://doi.org/10.1186/s12875-020-01107-y

Version

VoR (Version of Record)

Published in

BMC Family Practice

Volume

21

Issue

1

Pagination

52

Publisher

Springer Science and Business Media LLC

issn

1471-2296

eissn

1471-2296

Acceptance date

05/02/2020

Copyright date

2020

Spatial coverage

UK

Language

eng

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