Research article

Development of a theory of implementation and integration: Normalization Process Theory

Carl R May¹ , Frances Mair² , Tracy Finch¹ , Anne MacFarlane³ , Christopher Dowrick⁴ , Shaun Treweek⁵ , Tim Rapley¹ , Luciana Ballini⁶ , Bie Nio Ong⁷ , Anne Rogers⁸ , Elizabeth Murray⁹ , Glyn Elwyn¹⁰ , France Légaré¹¹ , Jane Gunn¹² and Victor M Montori¹³

¹  Institute of Health and Society, Newcastle University, Newcastle, UK

²  Division of General Practice, Glasgow University, Glasgow, UK

³  Department of General Practice, National University of Ireland, Galway, Ireland

⁴  School of Population and Behavioural Sciences, University of Liverpool, Liverpool, UK

⁵  Centre for Primary Care and Population Research, University of Dundee, Dundee, UK

⁶  Agenzia Sanitaria e Sociale Regionale, Bologna, Italy

⁷  Arthritis Research Campaign National Primary Care Centre, Keele University, Keele, UK

⁸  National Primary Care Research and Development Centre, University of Manchester, Manchester, UK

⁹  Department of Primary Care, University College London, London, UK

¹⁰  Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK

¹¹  Department of Family Medicine, Université Laval, Québec, Québec, Canada

¹²  Department of General Practice, University of Melbourne, Melbourne, Australia

¹³  Knowledge and Encounter Research Unit, Mayo Clinic, Rochester MN, USA

author email corresponding author email

Implementation Science 2009, 4:29doi:10.1186/1748-5908-4-29

Published:	21 May 2009

Abstract

Background

Theories are important tools in the social and natural sciences. The methods by which they are derived are rarely described and discussed. Normalization Process Theory explains how new technologies, ways of acting, and ways of working become routinely embedded in everyday practice, and has applications in the study of implementation processes. This paper describes the process by which it was built.

Methods

Between 1998 and 2008, we developed a theory. We derived a set of empirical generalizations from analysis of data collected in qualitative studies of healthcare work and organization. We developed an applied theoretical model through analysis of empirical generalizations. Finally, we built a formal theory through a process of extension and implication analysis of the applied theoretical model.

Results

Each phase of theory development showed that the constructs of the theory did not conflict with each other, had explanatory power, and possessed sufficient robustness for formal testing. As the theory developed, its scope expanded from a set of observed regularities in data with procedural explanations, to an applied theoretical model, to a formal middle-range theory.

Conclusion

Normalization Process Theory has been developed through procedures that were properly sceptical and critical, and which were opened to review at each stage of development. The theory has been shown to merit formal testing.