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Table 6 Revisited items for inclusion in Version 4

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

Construct Sub-Construct Online expert survey items Re-writes & exclusions Revised Version 4
Coherence is the sense-making work that people do individually and collectively when they are faced with the problem of operationalizing some sets of practices. Differentiation (1) I can distinguish the [intervention] from usual ways of working (2) I can see how the [intervention] differs from usual ways of working (3) The [intervention] is easy to describe (excluded) The [intervention] is easy to describe (1) I can distinguish the [intervention] from usual ways of working (2) I can see how the [intervention] differs from usual ways of working
Whether people can easily understand that the intervention is different from current ways of working
Communal specification (4) Staff in this organisation have a shared understanding of the purpose of this [intervention] (5) Staff in this organisation have shared expectations about the likelihood of the success of this [intervention]   (4) Staff in this organisation have a shared understanding of the purpose of this [intervention] (5) Staff in this organisation have shared expectations about the likelihood of the success of this [intervention]
Whether people can build a collective understanding of the purpose of the intervention
Individual specification    
Whether people understand the specific tasks and responsibilities that the intervention requires of them (6) I understand what tasks the [intervention] requires of me (7) I understand how the [intervention] affects the nature of my own work   (6) I understand what tasks the [intervention] requires of me (7) I understand how the [intervention] affects the nature of my own work
Internalization (8) I can see the potential value of the [intervention] for my work (9) I can see the worth of the [intervention] (10) I will benefit personally from being involved in the [intervention] (re-write) I can see the worth of the [intervention] (excluded) I will benefit personally from being involved in the [intervention] (8)I can see the potential value of the [intervention] for my work (9) I can see the worth of the [intervention] for me
Whether people can easily grasp the potential value of the intervention for their work
Cognitive participation is the relational work that people do to build and sustain a community of practice around a new technology or complex intervention. Initiation (1) There are key people who have the skills to drive the [intervention] forward (2) There are key people who drive the [intervention] forward and get others involved (3) There are individuals who enthusiastically involve others in the [intervention] (4) There are individuals who champion the [intervention]   (1) There are key people who have the skills to drive the [intervention] forward (2) There are key people who drive the [intervention] forward and get others involved (3) There are individuals who enthusiastically involve others in the [intervention] (4) There are individuals who champion the [intervention]
Whether key individuals are working to drive the intervention forward
Legitimation (5) I believe that participating in the [intervention] is a legitimate part of my role (6) The work of the [intervention] is consistent with my professional responsibilities (7) I can make an important contribution to the success of the [intervention]   (5) I believe that participating in the [intervention] is a legitimate part of my role (6) The work of the [intervention] is consistent with my professional responsibilities (7) I can make an important contribution to the success of the [intervention]
Whether people feel that they are the right people to be involved
Enrolment (8) I am able to contribute to delivering the [intervention] (9) I am willing to contribute to delivering the [intervention] (10) I can work with colleagues to deliver this [intervention] (re-write) I am able to contribute to delivering the [intervention] (re-write) I am willing to contribute to delivering the [intervention] (re-write) I can work with colleagues to deliver this [intervention] (8) Staff are open to new ways of working together to use the [intervention] (9) I’m open to working with colleagues in new ways to use the [intervention]
Whether people can organise themselves to contribute to the intervention
Activation (11) I feel motivated to continue to support the intervention (12) I will continue to support the [intervention] (13) Staff are willing to address any problems that arise in order to keep the [intervention] going (excluded) I feel motivated to continue to support the intervention (12) I will continue to support the [intervention] (13) Staff are willing to address any problems that arise in order to keep the [intervention] going
Whether people collectively work to support and sustain the intervention
Collective action is the operational work that people do to enact a set of practices, whether these represent a new technology or complex healthcare intervention. Interactional workability (1) I carry out the [intervention] tasks that are expected of me (2) I perform the tasks that are necessary to making the [intervention] work (3) The [intervention] does not make it difficult for me to do my job (4) The [intervention] makes my job easier (5) I am able to make the [intervention] a normal part of my work (6) I can easily integrate the [intervention] into my existing work (excluded) I carry out the [intervention] tasks that are expected of me (excluded) I perform the tasks that are necessary to making the [intervention] work (excluded) The [intervention] makes my job easier (3) The [intervention] does not make it difficult for me to do my job (5) I am able to make the [intervention] a normal part of my work (6) I can easily integrate the [intervention] into my existing work
Whether people can work with the intervention to perform the tasks required in their role
Relational Integration    
Whether people maintain trust in the intervention and trust in each other (7) I have confidence in others to deliver the [intervention] (8) The [intervention] disrupts working relationships (9) The [intervention] threatens trust between staff members (10) I have confidence in other people’s ability to use the [intervention]   (7) I have confidence in others to deliver the [intervention] (8) The [intervention] disrupts working relationships (9) The [intervention] threatens trust between staff members (10) I have confidence in other people’s ability to use the [intervention]
Skill set workability (11) Work is assigned to those with skills appropriate to the [intervention] (12) Sufficient support provided to enable staff to implement the [intervention] (13) The [intervention] makes good use of all staff members expertise (excluded) Sufficient support is provided to enable staff to implement the [intervention] (11) Work is assigned to those with skills appropriate to the [intervention] (12) Sufficient training is provided to enable staff to use the [intervention] **NOTE – This item was accidently removed from the online survey. (13) The [intervention] makes good use of all staff members expertise
Whether the work required by the intervention is allocated to people with the right mix of skills and training
Contextual Integration (14) Sufficient resources are available to support the [intervention] (15) Management adequately support the [intervention] (16) The [intervention] fits well with strategic goals of this organisation   (14) Sufficient resources are available to support the [intervention] (15) Management adequately support the [intervention] (16) The [intervention] fits well with strategic goals of this organisation
Whether the intervention is adequately supported in terms of money, strategy and other resources by its host organisation
Reflexive monitoring is the appraisal work that people do to assess and understand the ways that a new set of practices affect them and others around them. Systemisation (1) I have access to reports about the effects of the [intervention] (2) I have access to anecdotal evidence about the effects of the [intervention] (3) I am aware of reports about the effects of the [intervention] (4) I am aware of anecdotal evidence about the effects of the [intervention] (excluded) I am aware of anecdotal evidence about the effects of the [intervention] (1) I have access to reports about the effects of the [intervention] (2) I have access to anecdotal evidence about the effects of the [intervention] (3) I am aware of reports about the effects of the [intervention]
Whether people have access to information about the impact of the intervention
Communal Appraisal (5) The staff agree that the [intervention] is working well (6) The staff agree that the [intervention] is worthwhile   (5) The staff agree that the [intervention] is working well (6) The staff agree that the [intervention] is worthwhile
Whether people, through formal information, collectively agree that the intervention is worthwhile
Individual Appraisal (7) Staff agree that the [intervention] is worth the effort they put into it (8) Staff feel that the effects of the [intervention] are worth the effort they put into it (9) I value the effects the [intervention] has had on my work   (7) Staff agree that the [intervention] is worth the effort they put into it (8) Staff feel that the effects of the [intervention] are worth the effort they put into it (9) I value the effects the [intervention] has had on my work
Whether individuals involved in the intervention think it is worthwhile
Reconfiguration (10) Feedback about the [intervention] can be used to improve it in the future (11) I can see where improvements can be made to the [intervention] (12) Staff members have been able to contribute to decisions about how the [intervention] is implemented (re-write)I can see where improvements can be made to the [intervention] (re-write) Staff members have been able to contribute to decisions about how the [intervention] is implemented (10) Feedback about the [intervention] can be used to improve it in the future (11) I can modify aspects of the [intervention] (12) I can modify how I work with the [intervention]
Whether individuals or groups can modify their work in response to their appraisal of the intervention