• Carl R May, Frances S Mair, Christopher F Dowrick, and Tracy L Finch.
• Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK. c.r.may@ncl.ac.uk
• Bmc Fam Pract. 2007 Jul 24; 8: 4242.

BackgroundThe Normalization Process Model is a conceptual tool intended to assist in understanding the factors that affect implementation processes in clinical trials and other evaluations of complex interventions. It focuses on the ways that the implementation of complex interventions is shaped by problems of workability and integration.MethodIn this paper the model is applied to two different complex trials: (i) the delivery of problem solving therapies for psychosocial distress, and (ii) the delivery of nurse-led clinics for heart failure treatment in primary care.ResultsApplication of the model shows how process evaluations need to focus on more than the immediate contexts in which trial outcomes are generated. Problems relating to intervention workability and integration also need to be understood. The model may be used effectively to explain the implementation process in trials of complex interventions.ConclusionThe model invites evaluators to attend equally to considering how a complex intervention interacts with existing patterns of service organization, professional practice, and professional-patient interaction. The justification for this may be found in the abundance of reports of clinical effectiveness for interventions that have little hope of being implemented in real healthcare settings.

22 keywords...

hide…