• Carl May, Tracy Finch, Frances Mair, Luciana Ballini, Christopher Dowrick, Martin Eccles, Linda Gask, Anne MacFarlane, Elizabeth Murray, Tim Rapley, Anne Rogers, Shaun Treweek, Paul Wallace, George Anderson, Jo Burns, and Ben Heaven.
• Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK. c.r.may@ncl.ac.uk
• Bmc Health Serv Res. 2007 Jan 1; 7: 148.

BackgroundThe Normalization Process Model is a theoretical model that assists in explaining the processes by which complex interventions become routinely embedded in health care practice. It offers a framework for process evaluation and also for comparative studies of complex interventions. It focuses on the factors that promote or inhibit the routine embedding of complex interventions in health care practice.MethodsA formal theory structure is used to define the model, and its internal causal relations and mechanisms. The model is broken down to show that it is consistent and adequate in generating accurate description, systematic explanation, and the production of rational knowledge claims about the workability and integration of complex interventions.ResultsThe model explains the normalization of complex interventions by reference to four factors demonstrated to promote or inhibit the operationalization and embedding of complex interventions (interactional workability, relational integration, skill-set workability, and contextual integration).ConclusionThe model is consistent and adequate. Repeated calls for theoretically sound process evaluations in randomized controlled trials of complex interventions, and policy-makers who call for a proper understanding of implementation processes, emphasize the value of conceptual tools like the Normalization Process Model.

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