Open Access Open Badges Research article

What work has to be done to implement collaborative care for depression? Process evaluation of a trial utilizing the Normalization Process Model

Linda Gask1*, Peter Bower1, Karina Lovell2, Diane Escott2, Janine Archer2, Simon Gilbody3, Annette J Lankshear4, Angela E Simpson3 and David A Richards5

Author Affiliations

1 National Primary Care Research and Development Centre, University of Manchester, Oxford Road, Manchester UK

2 School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester, UK

3 Department of Health Sciences, Hull York Medical School (HYMS), Seebohm Rowntree Building, University of York, York, UK

4 Cardiff School of Nursing and Midwifery Studies, Cardiff University, Caerleon Campus, Cardiff, UK

5 School of Psychology, University of Exeter, Washington Singer Building, Perry Road, Exeter, UK

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Implementation Science 2010, 5:15  doi:10.1186/1748-5908-5-15

Published: 10 February 2010



There is a considerable evidence base for 'collaborative care' as a method to improve quality of care for depression, but an acknowledged gap between efficacy and implementation. This study utilises the Normalisation Process Model (NPM) to inform the process of implementation of collaborative care in both a future full-scale trial, and the wider health economy.


Application of the NPM to qualitative data collected in both focus groups and one-to-one interviews before and after an exploratory randomised controlled trial of a collaborative model of care for depression.


Findings are presented as they relate to the four factors of the NPM (interactional workability, relational integration, skill-set workability, and contextual integration) and a number of necessary tasks are identified. Using the model, it was possible to observe that predictions about necessary work to implement collaborative care that could be made from analysis of the pre-trial data relating to the four different factors of the NPM were indeed borne out in the post-trial data. However, additional insights were gained from the post-trial interview participants who, unlike those interviewed before the trial, had direct experience of a novel intervention. The professional freedom enjoyed by more senior mental health workers may work both for and against normalisation of collaborative care as those who wish to adopt new ways of working have the freedom to change their practice but are not obliged to do so.


The NPM provides a useful structure for both guiding and analysing the process by which an intervention is optimized for testing in a larger scale trial or for subsequent full-scale implementation.