Table 1

Normalisation process theory (NPT): constructs and components21

NPT construct	Component	Explanation
Coherence Sense-making work: understanding and conceptualisation of interventions and their work.	Differentiation	What people do to understand how a set of practices and their objects are different from each other. What they do to organise the differences.
	Communal specification	People working together to build a shared understanding of the aims, objectives and expected benefits of a set of practice. How a team works out how to integrate an innovation into their healthcare setting.
	Individual specification	Individuals’ understanding of their specific tasks and responsibilities around a set of practices.
	Internalisation	Work to understand the value, benefits and importance of a set of practices. The work people do to attribute worth to a new way of working.
Cognitive participation Relational work that people do to build and sustain a community of practice around a new technology or complex intervention: notions of legitimation and buy-in, both in terms of the individuals involved and involving others.	Initiation	The work people do to drive forward the new or modified practice. Setting things up and working with others to make things happen.
	Enrolment	How participants organise and reorganise themselves and others in order to collectively contribute to the work involved in new practices. This is complex work that may involve rethinking individual and group relationships between people and things.
	Legitimation	The work ensuring that other participants believe it is right for them to be involved, and that they can make a valid contribution to it.
	Activation	The work of keeping the new practices in view and connecting them with the people who need to be doing them. Collectively defining the actions and procedures needed to sustain a practice and to stay involved.
Collective action Operational work that people do to enact a set of practices: organisational resources, training, division of labour, confidence and expertise as well as the workability of the intervention in clinical interaction	Interactional workability	The interactional work that people do with each other, with artefacts and with other elements of a set of practices, when they seek to operationalise them in everyday settings. The impact the new practice has on interactions with each other and/or service users.
	Relational integration	The knowledge work that people do to build accountability and maintain confidence in a set of practices and in each other as they use them. The impact the innovation has on relationships between different groups of professionals for example, trust, accountability and responsibility.
	Skill set workability	The allocation work that underpins the division of labour that is built up around a set of practices as they are operationalised in the real world. Who gets to do/did what and how the tasks relate to their existing skill sets.
	Contextual integration	The resource work—managing a set of practices through the allocation of different kinds of resources and the execution of protocols, policies and procedures. Fit between the new practice and overall organisational context, including organisational goals, morale, leadership and distribution of resources (eg, funding, policy and priorities).
Reflexive monitoring Appraising and monitoring implementation 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.	Systematisation	The work of collecting information in a variety of ways to determine how effective and useful the new practice is for them and for others.
	Communal appraisal	Participants work together—sometimes in formal collaboratives, sometimes in informal groups to evaluate the worth of a set of practices.
	Individual appraisal	Individuals appraising the new practice in relation to their own work; the impact it has on their tasks. Actions through which individuals express their personal relationship with the innovation.
	Reconfiguration	The appraisal work by individuals or groups which may lead to attempts to redefine procedures or modify practices—and even to change the shape of the innovation itself.