Table 3 Normalisation Process Theory (NPT) coding template

Coherence (sensemaking work) Sensemaking work that is undertaken individually or collectively when attempting to incorporate a new set of practices into existing activities. Defines and organises the objects of a practice. (Do people know what the work is?)

Differentiation: How people come to an understanding about how sets of practices and their objects are different to each other.

Communal specification: How people work together to build a shared understanding of the aims, objectives, and expected benefits of a set of practices.

Individual specification: The work individuals do to help them understand their specific tasks and responsibilities around a set of practices.

Internalisation: The work people do to understand the value, benefits and importance of a set of practices.

Cognitive participation (commitment/engagement/buy in work) The relational work people do to build and sustain commitment to a community of practice around a new set of practices - the enrolment and engagement of participants in a practice. (Are people prepared to join in with the work practice?)

Legitimation: Participants work to produce agreement about the legitimacy of a new set of practices. Do individuals believe it is right (legitimate) for them to be involved? Do they feel they can make a valid contribution to implementation?

Enrolment: Taking account of whether or not key participants are working to initiate new practices.

Initiation: Participants work to bring a new set of practices into being in specific times and places, investing commitment as they introduce it in practice.

Activation: Participants work to produce and reproduce continued commitment to new practices, sustaining involvement in new practices. PHIMs in health promotion practice, sustaining involvement in monitoring of health promotion practice over time.

Collective action (enacting work) Purposive, operational work that defines and organises the enacting of a practice - interaction with already existing practices; Knowledge work that people do to build accountability and maintain confidence in a set of practices and in each other as they use them. (How do people do the work?)

Contextual integration: The capacity of an organisation to understand and agree to the allocation of resources, infrastructure and policy in order to implement a complex intervention, and to negotiate its integration into existing patterns of activity. Proposition: Normalisation is likely if it confers an advantage on an organisation in flexibly executing and realising work.

Relational integration ^a : (the embeddedness of trust in professional knowledge and practice). The network of relations in which encounters between agents (professionals and clients) are located, and through which knowledge and practice relating to a complex intervention is defined and mediated. Proposition: Normalisation is likely if it equals or improves accountability and confidence within networks.

Interactional workability: The interaction of agents (professionals, clients, others) in operationalising a complex intervention. Proposition: Normalisation is likely if it confers an interactional advantage in flexibly accomplishing congruence (co-operation and legitimacy) and disposal (shared expectations about goals, meaning and outcomes of the new practices).

Skill set workability: The organisational distribution of work, knowledge and practice across divisions of labour. The formal and informal divisions of labour in health care settings, and the mechanisms by which knowledge and practice about complex interventions are distributed. Proposition: Normalisation is likely if a complex intervention is calibrated to an agreed skill-set at a recognisable location in the division of labour.

Reflexive monitoring (appraisal work) The appraisal work that people do to assess and understand the ways that a new set of practices affect them and others around them, including determining how effective and useful the new practices are for themselves and others. Information is gathered both experientially and systematically by individuals and by formal and informal groups to evaluate practices. This work may lead to attempts to redefine procedures or modify practices or the new technology itself.

Systematisation: Participants work to define, collect, and collate information about the effects of new practices.

Communal appraisal: Participants work to assess the collective utility and value of new practices according to their place in the healthcare system.

Individual appraisal: Participants work to appraise their experience of the value of new practices.

Reconfiguration: Participants work to inform changes in patterns of participation and action, informing changes in the way that new practices are enacted.