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Table 1 Original 16 NPT toolkit items

From: Improving the normalization of complex interventions: part 1 - development of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT)

Coherence

Collective Action

Sub-construct

Original NPT toolkit item

Sub-construct

Original NPT toolkit item

Differentiation: Whether the [intervention] is easy to describe to participants and whether they can appreciate how it differs or is clearly distinct from current ways of working.

Participants distinguish the intervention from current ways of working

Initiation: Whether or not key individuals are able and willing to get others involved in the new practice.

Key individuals drive the intervention forward

Communal specification: Whether participants have or are able to build a shared understanding of the aims, objectives, and expected outcomes of the proposed [intervention].

Participants collectively agree about the purpose of the intervention

Legitimation: Whether or not participants believe it is right for them to be involved, and that they can make a valid contribution

Participants agree that the intervention is a legitimate part of their work

Individual specification: Whether individual participants have or are able to make sense of the work – specific tasks and responsibilities - the proposed [intervention] would create for them.

Participants individually understand what the intervention requires of them

Enrolment: The capacity and willingness of participants to organize themselves in order to collectively contribute to the work involved in the new practice.

Participants buy in to delivering the intervention

Internalization: Whether participants have or are able to easily grasp the potential value, benefits and importance of the [intervention].

Participants construct potential value of the intervention for them/their work

Activation: The capacity and willingness of participants to collectively define the actions and procedures needed to keep the new practice going.

Participants continue to support the intervention

Cognitive Participation

Reflexive Monitoring

Sub-construct

Original NPT toolkit item

Sub-construct

Original NPT toolkit item

Interactional Workability: Whether people are able to enact the [intervention] and operationalise its components in practice

Participants perform the tasks required by the intervention

Systematization: Whether participants can determine how effective and useful the [intervention] is from the use of formal and/or informal evaluation methods

Participants access information about the effects of the intervention

Relational Integration: Whether people maintain trust in the [intervention] and in each other.

Participants maintain their trust in each other’s work and expertise through the intervention

Communal appraisal: Whether, as a result of formal monitoring, participants collectively agree about the worth of the effects of the [intervention]

Participants collectively assess the intervention as worthwhile for others

Skill set Workability: Whether the work required by the [intervention] is seen to be parcelled out to participants with the right mix of skills and training to do it

The work of the intervention is appropriately allocated to participants

Individual appraisal: Whether individuals involved with, or affected by, the [intervention], think it is worthwhile.

Participants individually assess the intervention as worthwhile for themselves

Contextual Integration: Whether the [intervention] is supported by management and other stakeholders, policy, money and material resources.

The intervention is adequately supported by its host organization

Reconfiguration: Whether individuals or groups using the [intervention] can make changes as a result of individual and communal appraisal.

Participants modify their work in response to their appraisal of the intervention