Translational framework for implementation evaluation and research: implementation strategies derived from normalization process theory
Abstract Background Implementation strategies are deliberate systematic actions used to support the uptake of innovations in health and social care. While widely used taxonomies such as ERIC and EPOC have emerged from consensus exercises, few implementation strategies are explicitly derived from the...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-07-01
|
| Series: | Implementation Science |
| Online Access: | https://doi.org/10.1186/s13012-025-01444-5 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849235123651739648 |
|---|---|
| author | Carl R. May Alyson Hillis Bianca Albers Laura Desveaux Anthony Gilbert Melissa Girling Roman Kislov Anne MacFarlane Frances S. Mair Sebastian Potthoff Tim Rapley Tracy L. Finch |
| author_facet | Carl R. May Alyson Hillis Bianca Albers Laura Desveaux Anthony Gilbert Melissa Girling Roman Kislov Anne MacFarlane Frances S. Mair Sebastian Potthoff Tim Rapley Tracy L. Finch |
| author_sort | Carl R. May |
| collection | DOAJ |
| description | Abstract Background Implementation strategies are deliberate systematic actions used to support the uptake of innovations in health and social care. While widely used taxonomies such as ERIC and EPOC have emerged from consensus exercises, few implementation strategies are explicitly derived from theory and tested against empirical data. This study develops a taxonomy of implementation strategies grounded in Normalization Process Theory (NPT), an implementation theory that explains how new practices become embedded and sustained. Methods We conducted a qualitative evidence synthesis of studies that reported implementation projects informed by NPT. Studies were identified through citation tracking and database searches, screened using pre-specified criteria, and appraised for methodological quality. Using the NPT coding manual, we identified implementation mechanisms described in each study and translated these into candidate implementation strategies. These were then tested against all included studies through iterative qualitative content analysis. Result Searches led to 9,147 references, and we then eliminated 5,708 duplicates. After title and abstract screening a further 1,443 were eliminated. Full text screening was undertaken with 1,996 papers, and 1,411 of these were eliminated. This left 585 papers subjected to quality assessment, of which 522 were eliminated. Finally, 63 papers were included in the review. Qualitative analysis of included papers yielded 24 general strategies linked to NPT’s theoretical constructs and 96 micro-strategies representing four domains of implementation activity: leadership, information, empowerment, and service user involvement. Each strategy was explicitly linked to an NPT construct. Conclusions This study provides a theory-based and empirically grounded set of actionable implementation strategies. These are grounded in qualitative descriptions of implementation work. These strategies support practical decision-making across the planning, delivery, and sustainment phases of implementation, and offer context-sensitive guidance for adapting interventions to diverse settings. Unlike consensus-based taxonomies, these strategies are tied to observable mechanisms of action, enabling users to better understand and respond to the dynamic and socially organised nature of implementation. The NPT taxonomy of implementation strategies can support the design, tailoring, and operationalisation of implementation efforts across varied health and social care contexts. |
| format | Article |
| id | doaj-art-19ea2677c87c4940a2b22307fb02b5d4 |
| institution | Kabale University |
| issn | 1748-5908 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj-art-19ea2677c87c4940a2b22307fb02b5d42025-08-20T04:02:54ZengBMCImplementation Science1748-59082025-07-0120111510.1186/s13012-025-01444-5Translational framework for implementation evaluation and research: implementation strategies derived from normalization process theoryCarl R. May0Alyson Hillis1Bianca Albers2Laura Desveaux3Anthony Gilbert4Melissa Girling5Roman Kislov6Anne MacFarlane7Frances S. Mair8Sebastian Potthoff9Tim Rapley10Tracy L. Finch11Department of Health Services Research and Policy, London, School of Hygiene and Tropical MedicineDepartment of Health Services Research and Policy, London, School of Hygiene and Tropical MedicineInstitute for Implementation Science in Health Care, University of ZurichLearning Health System Program Institute for Better Health, Trillium Health PartnersRoyal National Orthopaedic HospitalDepartment of Nursing, Midwifery & Health, Northumbria University, Coach Lane CampusManchester Metropolitan University, Business SchoolWHO Collaborating Centre for Participatory Health Research With Refugees and Migrants, School of Medicine, University of LimerickGeneral Practice & Primary Care, School of Health and Wellbeing, University of GlasgowDepartment of Social Work, Education and Community Wellbeing, Northumbria University, Coach Lane CampusDepartment of Social Work, Education and Community Wellbeing, Northumbria University, Coach Lane CampusDepartment of Nursing, Midwifery & Health, Northumbria University, Coach Lane CampusAbstract Background Implementation strategies are deliberate systematic actions used to support the uptake of innovations in health and social care. While widely used taxonomies such as ERIC and EPOC have emerged from consensus exercises, few implementation strategies are explicitly derived from theory and tested against empirical data. This study develops a taxonomy of implementation strategies grounded in Normalization Process Theory (NPT), an implementation theory that explains how new practices become embedded and sustained. Methods We conducted a qualitative evidence synthesis of studies that reported implementation projects informed by NPT. Studies were identified through citation tracking and database searches, screened using pre-specified criteria, and appraised for methodological quality. Using the NPT coding manual, we identified implementation mechanisms described in each study and translated these into candidate implementation strategies. These were then tested against all included studies through iterative qualitative content analysis. Result Searches led to 9,147 references, and we then eliminated 5,708 duplicates. After title and abstract screening a further 1,443 were eliminated. Full text screening was undertaken with 1,996 papers, and 1,411 of these were eliminated. This left 585 papers subjected to quality assessment, of which 522 were eliminated. Finally, 63 papers were included in the review. Qualitative analysis of included papers yielded 24 general strategies linked to NPT’s theoretical constructs and 96 micro-strategies representing four domains of implementation activity: leadership, information, empowerment, and service user involvement. Each strategy was explicitly linked to an NPT construct. Conclusions This study provides a theory-based and empirically grounded set of actionable implementation strategies. These are grounded in qualitative descriptions of implementation work. These strategies support practical decision-making across the planning, delivery, and sustainment phases of implementation, and offer context-sensitive guidance for adapting interventions to diverse settings. Unlike consensus-based taxonomies, these strategies are tied to observable mechanisms of action, enabling users to better understand and respond to the dynamic and socially organised nature of implementation. The NPT taxonomy of implementation strategies can support the design, tailoring, and operationalisation of implementation efforts across varied health and social care contexts.https://doi.org/10.1186/s13012-025-01444-5 |
| spellingShingle | Carl R. May Alyson Hillis Bianca Albers Laura Desveaux Anthony Gilbert Melissa Girling Roman Kislov Anne MacFarlane Frances S. Mair Sebastian Potthoff Tim Rapley Tracy L. Finch Translational framework for implementation evaluation and research: implementation strategies derived from normalization process theory Implementation Science |
| title | Translational framework for implementation evaluation and research: implementation strategies derived from normalization process theory |
| title_full | Translational framework for implementation evaluation and research: implementation strategies derived from normalization process theory |
| title_fullStr | Translational framework for implementation evaluation and research: implementation strategies derived from normalization process theory |
| title_full_unstemmed | Translational framework for implementation evaluation and research: implementation strategies derived from normalization process theory |
| title_short | Translational framework for implementation evaluation and research: implementation strategies derived from normalization process theory |
| title_sort | translational framework for implementation evaluation and research implementation strategies derived from normalization process theory |
| url | https://doi.org/10.1186/s13012-025-01444-5 |
| work_keys_str_mv | AT carlrmay translationalframeworkforimplementationevaluationandresearchimplementationstrategiesderivedfromnormalizationprocesstheory AT alysonhillis translationalframeworkforimplementationevaluationandresearchimplementationstrategiesderivedfromnormalizationprocesstheory AT biancaalbers translationalframeworkforimplementationevaluationandresearchimplementationstrategiesderivedfromnormalizationprocesstheory AT lauradesveaux translationalframeworkforimplementationevaluationandresearchimplementationstrategiesderivedfromnormalizationprocesstheory AT anthonygilbert translationalframeworkforimplementationevaluationandresearchimplementationstrategiesderivedfromnormalizationprocesstheory AT melissagirling translationalframeworkforimplementationevaluationandresearchimplementationstrategiesderivedfromnormalizationprocesstheory AT romankislov translationalframeworkforimplementationevaluationandresearchimplementationstrategiesderivedfromnormalizationprocesstheory AT annemacfarlane translationalframeworkforimplementationevaluationandresearchimplementationstrategiesderivedfromnormalizationprocesstheory AT francessmair translationalframeworkforimplementationevaluationandresearchimplementationstrategiesderivedfromnormalizationprocesstheory AT sebastianpotthoff translationalframeworkforimplementationevaluationandresearchimplementationstrategiesderivedfromnormalizationprocesstheory AT timrapley translationalframeworkforimplementationevaluationandresearchimplementationstrategiesderivedfromnormalizationprocesstheory AT tracylfinch translationalframeworkforimplementationevaluationandresearchimplementationstrategiesderivedfromnormalizationprocesstheory |