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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