Translational framework for implementation evaluation and research: a normalisation process theory coding manual for qualitative research and instrument development

Abstract

Background Normalisation Process Theory (NPT) is frequently used to inform qualitative research that aims to explain and evaluate processes that shape late-stage translation of innovations in the organisation and delivery of healthcare. A coding manual for qualitative researchers using NPT will facilitate transparent data analysis processes and will also reduce the cognitive and practical burden on researchers. Objectives (a) To simplify the theory for the user. (b) To describe the purposes, methods of development, and potential application of a coding manual that translates normalisation process theory (NPT) into an easily usable framework for qualitative analysis. (c) To present an NPT coding manual that is ready for use. Method Qualitative content analysis of papers and chapters that developed normalisation process theory, selection and structuring of theory constructs, and testing constructs against interview data and published empirical studies using NPT. Results A coding manual for NPT was developed. It consists of 12 primary NPT constructs and conforms to the Context-Mechanism-Outcome configuration of realist evaluation studies. Contexts are defined as settings in which implementation work is done, in which strategic intentions, adaptive execution, negotiating capability, and reframing organisational logics are enacted. Mechanisms are defined as the work that people do when they participate in implementation processes and include coherence-building, cognitive participation, collective action, and reflexive monitoring. Outcomes are defined as effects that make visible how things change as implementation processes proceed and include intervention mobilisation, normative restructuring, relational restructuring, and sustainment. Conclusion The coding manual is ready to use and performs three important tasks. It consolidates several iterations of theory development, makes the application of NPT simpler for the user, and links NPT constructs to realist evaluation methods. The coding manual forms the core of a translational framework for implementation research and evaluation.

Translational framework for implementation evaluation and research: Protocol for a qualitative systematic review of studies informed by Normalization Process Theory (NPT)

“…The design and conduct of this systematic review combines abductive 20 'manual' qualitative analyses of primary studies that have passed quality assurance screening and that uses a coding manual based on NPT 12 (and which will also allow the incorporation of insights from other theories where these are used in combination with NPT); a manual mega-aggregation analysis 21 of reviews and other secondary studies using the same coding manual; and an automated topic modelling analysis of the whole corpus of papers using Leximancer® software (Leximancer® Pty Ltd. Leximancer® Qualitative Analysis Software, Release 4.5: 2009). The workflow for the programme of research is described in Figure 2.…”

“…Formal data for analysis will be the results, discussion and conclusion sections of included papers. This will combine abductive analysis (searching for unexpected phenomena of interest in the data), and deductive analysis using an NPT coding manual developed for this review 12 . A synopsis of the coding manual is given in Table 2.…”

“…The theory thus focuses on interdependent and purposive social action and identifies mechanisms that have been empirically demonstrated to play a significant role in social processes of implementation. Methodological work to support this review 12 has refined and consolidated the iterations of NPT developed between 2006 and 2020 [3][4][5][6][7][8][9][10][11] , into a set of 12 primary constructs. Relations between NPT constructs characterising implementation contexts, mechanisms, and outcomes are described in Figure 1.…”

“…Relations between NPT constructs characterising implementation contexts, mechanisms, and outcomes are described in Figure 1. These form the basis of a generalisable coding manual for qualitative research using NPT 12 . This protocol sets out the foundation and procedures of a qualitative synthesis of studies that have used NPT in implementation research and process evaluation in healthcare.…”

Do general practitioners working in or alongside the emergency department improve clinical outcomes or experience? A mixed-methods study

“…20 Through its four core constructs of coherence, cognitive participation, collective action and reflexive monitoring (box 1) 20 21 NPT can support both the understanding and evaluation of the implementation of organisational innovations such as GPED. 27 Its use has been supported by empirical studies using both qualitative and quantitative methods-therefore it was a particularly useful framework to apply in this context, given our study aims. 28 29 NPT enabled us to integrate our qualitative and quantitative data; examining the extent to which GPED had become a part of routine practice and highlighting the related impact on patients and staff.…”