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Table 2 Four generative mechanisms of Normalization Process Theory

From: Patchy ‘coherence’: using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC)

Generative mechanism Description Components
Coherence The sense-making work that people do individually and collectively when they are faced with the problem of operationalizing some set of practices. Differentiation
Communal Specification
Individual Specification
Internalization
Cognitive participation The relational work that people do to build and sustain a community of practice around a new technology or complex intervention. Initiation
Enrolment
Legitimation
Activation
Collective action The operational work that people do to enact a set of practices, whether these represent a new technology or complex healthcare interventions. Interactional Workability
Relational Integration
Skillset Workability
Contextual Integration
Reflexive monitoring The appraisal work that people do to assess and understand the ways that a new set of practices affect them and others around them. Systemization
Communal Appraisal
Individual Appraisal
Reconfiguration