ArticleImplementation science : IS2008
Arduous implementation: does the Normalisation Process Model explain why it's so difficult to embed decision support technologies for patients in routine clinical practice.
Article in Implementation science : IS, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 85 papers, 6 of them syntheses that pooled it.
What it found
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The trial behind it
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Who cites it
85 citing papers in PubMed, 6 syntheses or guidelines pooled it, 163 citations in OpenAlex.
- Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review.Implementation science : IS · 2018Pooled it
- Barriers to advance care planning at the end of life: an explanatory systematic review of implementation studies.PloS one · 2015Pooled it
- A qualitative systematic review of studies using the normalization process theory to research implementation processes.Implementation science : IS · 2014Pooled it
- The challenges of implementing a telestroke network: a systematic review and case study.BMC medical informatics and decision making · 2013Pooled it
- "Many miles to go …": a systematic review of the implementation of patient decision support interventions into routine clinical practice.BMC medical informatics and decision making · 2013Pooled it
- Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review.Bulletin of the World Health Organization · 2012Pooled it
- Trial
- Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices.Implementation science : IS · 2021Trial
- Effect of a Mammography Screening Decision Aid for Women 75 Years and Older: A Cluster Randomized Clinical Trial.JAMA internal medicine · 2020Trial
- Trial
- Using normalisation process theory to understand workflow implications of decision support implementation across diverse primary care settings.BMJ health & care informatics · 2019Trial
- Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation.Social psychiatry and psychiatric epidemiology · 2019Trial
- Trial
- The electronic medication complete communication (EMCContemporary clinical trials · 2016Trial
- A multifaceted quality improvement intervention for CVD risk management in Australian primary healthcare: a protocol for a process evaluation.Implementation science : IS · 2014Trial
- One size does not fit all: evaluating an intervention to reduce antibiotic prescribing for acute bronchitis.BMC health services research · 2013Trial
- IMPaCT Back study protocol. Implementation of subgrouping for targeted treatment systems for low back pain patients in primary care: a prospective population-based sequential comparison.BMC musculoskeletal disorders · 2010Trial
- Protocol for the Osteoporosis Choice trial. A pilot randomized trial of a decision aid in primary care practice.Trials · 2009Trial
- Real-world implementation of a decision aid for treatment decisions in metastatic pancreatic cancer: a prospective multicenter study across expert centers.The oncologist · 2026Observational
- Stroke minimization through additive anti-atherosclerotic agents in routine treatment (SMAART) II: Rationale for a multi-country polypill phase 3 trial in sub-Saharan Africa.Equity neuroscience · 2026Article
25 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDecision support technologies (DSTs, also known as decision aids) help patients and professionals take part in collaborative decision-making processes. Trials have shown favorable impacts on patient knowledge, satisfaction, decisional conflict and confidence. However, they have not become routinely embedded in health care settings. Few studies have approached this issue using a theoretical framework. We explained problems of implementing DSTs using the Normalization Process Model, a conceptual model that focuses attention on how complex interventions become routinely embedded in practice.
methodsThe Normalization Process Model was used as the basis of conceptual analysis of the outcomes of previous primary research and reviews. Using a virtual working environment we applied the model and its main concepts to examine: the 'workability' of DSTs in professional-patient interactions; how DSTs affect knowledge relations between their users; how DSTs impact on users' skills and performance; and the impact of DSTs on the allocation of organizational resources.
resultsA conceptual analysis using the Normalization Process Model provided insight on implementation problems for DSTs in routine settings. Current research focuses mainly on the interactional workability of these technologies, but factors related to divisions of labor and health care, and the organizational contexts in which DSTs are used, are poorly described and understood.
conclusionThe model successfully provided a framework for helping to identify factors that promote and inhibit the implementation of DSTs in healthcare and gave us insights into factors influencing the introduction of new technologies into contexts where negotiations are characterized by asymmetries of power and knowledge. Future research and development on the deployment of DSTs needs to take a more holistic approach and give emphasis to the structural conditions and social norms in which these technologies are enacted.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.