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Table 4 Influences on normalisation of FV screening using NPT constructs

From: Applying normalization process theory to understand implementation of a family violence screening and care model in maternal and child health nursing practice: a mixed method process evaluation of a randomised controlled trial

NPT construct Influencing factors
Coherence or ‘sense making work’ Enablers:
   • Previous FV work
   • Increased discussion of the FV work in team meetings
  Barriers:
   • Time of significant change with introduction of KAS framework
   • Some participants misunderstood their role and in several areas, frequent staff changes impacted on implementation
Cognitive participation or ‘participation work’ Enablers:
   • Favourable responses of women and the perceived client consciousness raising (primary prevention)
   • Continual team discussions on FV work
  Barriers:
   • Lack of privacy to screen in consultations
   • Heavy workloads and competing client demands
   • Limited FV service support
Collective action or ‘enacting work’  
  Enablers:
   • Use of the maternal health and wellbeing checklist at 3–4 months enhanced client-nurse interaction and was a ‘good fit’ into the government guidelines
   • Planting a seed by multiple asking points
   • FV liaison worker
   • Adequate knowledge and skill set
  Barriers:
   • Poor organisational structure - limited ability to link with other team members or services
   • Low funding and disproportionate allocation of FV liaison worker support to some teams
Reflexive monitoring or ‘appraisal work’ Enablers:
   • Clinical supervision allowed for individual reflection
  Barriers:
   • Lack of awareness that evaluation and monitoring was required
   • Absence of formal reporting systems in both MCH and FV service
  1. [21,32,42].