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Table 4 Normalization process theory: the work of implementation

From: Implementing a training intervention to support caregivers after stroke: a process evaluation examining the initiation and embedding of programme change

Four interrelated generative mechanisms (after May & Finch [[11]]; Mayet al. [[2]]).
Contexts Generative mechanisms Explanation
The generative mechanisms are considered to be in dynamic interaction and are influenced by individual and wider, professional, local practice and organizational contexts Coherence Coherence [individually and collectively]relates to: how the work that defines and organizes a practice/intervention is understood, rendered meaningful and invested in, in respect of the knowledge, skills, behaviours, actors and actions required to implement it.
  Cognitive participation Cognitive participation relates to: commitment to and engagement of participants with the intervention. Do participants view the intervention as something worthwhile and appropriate to commit their individual time and effort [signing up] to bring about the intended outcome?
  Collective action Collective action relates to: the work that will be required of participants to implement the intervention, including preparation and/or training. How far will existing work practices and the division of labour have to be changed or adapted to implement the intervention? Is the intervention consistent with the existing norms and goals of the groups, the workplace and overall organization [this is policy, practice and service user linked]
  Reflexive monitoring Reflexive monitoring relates to: participants’ individual and collective on-going formal and informal appraisal of the intervention and its benefits for participants, in relation to realizing individual and organizational goals.