Process evaluation for complex interventions in primary care: understanding trials using the normalization process model

May, Carl R, Mair, Frances S, Dowrick, Christopher F and Finch, Tracy L
(2007) Process evaluation for complex interventions in primary care: understanding trials using the normalization process model. BMC Family Practice, 8 (1).

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Background: The 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. Method: In 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. Results: Application 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. Conclusion: The 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.

Item Type: Article
Additional Information: 9 pages (page numbers not for citation purposes). Published: 24 July 2007.
Subjects: ?? R1 ??
Divisions: Faculty of Health and Life Sciences > Institute of Population Health
Depositing User: Symplectic Admin
Date Deposited: 24 Jun 2008 12:50
Last Modified: 17 Dec 2022 01:31
DOI: 10.1186/1471-2296-8-42
Publisher's Statement : © 2007 May et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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