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Table 2 Constructs and dimensions of the normalisation process model (NPM)

From: Implementing a provider-initiated testing and counselling (PITC) intervention in Cape town, South Africa: a process evaluation using the normalisation process model

Constructs Dimensions
Interactional workability The interactional workability construct seeks to examine whether the complex intervention promotes ease and efficiency of interaction between people and practice. The model proposes that the new intervention is more likely to be normalised if the intervention maintains or enhances existing norms and social relations. Congruence Congruence requires shared expectations of normal conduct and purpose of the clinical encounter.
Disposal of work This requires an investigation into the level of agreement about the meaning and consequences of the work and of expectations about its goals.
Relational integration The relational workability construct investigates the extent to which the complex intervention can be integrated with existing knowledge, practices and relationships. The model proposes that normalisation is more likely if the intervention maintains or improves accountability and confidence within existing professional networks. Accountability Accountability requires agreement about the validity and expertise of knowledge and role divisions underpinning the work.
Confidence Confidence requires agreement on the credibility and utility of the knowledge and expertise, and the criteria by which it is evaluated.
Skills-set workability Skills-set workability is concerned with how the current division of labour is affected by the intervention, the capacity of participants to deploy the required tasks and how the quality of the work is monitored. The model proposes that normalisation is more likely if the intervention has a good fit with an actual or realisable division of labour. Allocation Allocation requires agreement on the formal and informal rules about the assignment of tasks, beliefs about ownership and appraisal of skills, rewards linked to roles and how work is monitored.
Performance Performance involves the ability of the organisation and people to deploy the intervention as planned and includes agreement about the tasks, boundaries, responsibility and autonomy of participants.
Contextual integration Contextual integration focuses on how the organisation uses its capacity and resources in the normalisation of the complex intervention. The model proposes that the complex intervention is more likely to be normalised if the organisation is able to be responsive and flexible in executing the work. Execution Refers to the organisational factors influencing practical implementation and monitoring of the intervention. This includes decisions about distributing responsibility, power and resources and linkages to organisational structures.
Realisation Realisation is made possible by agreement about the value of the intervention, policies about procurement, delivery of personnel and equipment and mechanisms for modifying organisational objectives.
  1. (Adapted from May et. al, 2007 [23]).