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Table 3 Alverbratt et al. operationalise all constructs and subconstructs of NPT [65]. (Reproduced from the Journal of Hospital Medicine published under Creative Commons Attribution (CC-BY) licence)

From: Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review

Coherence
‘The significant qualities DLDA)
Cognitive participation ‘Enrolment and engagement of individuals and groups’ Collective action ‘Interaction with already existing practices’ Reflexive monitoring ‘How a practice is understood and assessed by actors implicated in it’
Differentiation. Understanding the difference between DLDA and ‘the old fashioned way’ of working in a psychiatric nursing context. Initiation. The participants’ motivation in trying to incorporate the DLDA Tool. Interactional workability. Operating DLDA. Systematisation. The participants’ judgement of DLDA regarding usefulness and effectiveness.
Communal specification. The process through which users through teamwork share and create an understanding of this new practice. Enrolment. The work participants do to organise themselves and their co-workers in the practice of DLDA. Relational integration. Participants understandings of DLDA not only being aware of how and when to use DLDA, but also understanding the expressions of other staff members. Communal appraisal. Communal appraisal regarding the outcomes and values of DLDA.
Individual specification. The process in which users create an understanding of the new practice. Legitimation. The belief that DLDA is right for the context in terms of being a needed complement to existing tools and approaches. Skill-set workability. Refers to how DLDA is conducted and distributed. This will influence how the work is defined and divided between participants. Individual appraisal. Individual appraisal regarding the outcomes and value of DLDA.
Internalised meaning. The coherence of DLDA was based on the meaning users collectively invest in it. Activation of DLDA. What the participants could do together to improve conditions for DLDA to be sustained and become part of daily practice. Contextual integration. The incorporation of DLDA into a social context of the current wards. Reconfiguration. Suggestions from participants that aim to modify and enhance the utility of the DLDA Tool.