In this bibliography of NPT studies, we have included the ‘core set’ of papers, papers that document the development NPT, alongside empirical papers that draw on NPT to shape their research approach.

The first phase of developing Normalization Process Theory involved mapping the contingent (May, et al. 2003a) and normative (May, et al. 2003b) elements of embedding processes. This early work developed the concept of normalization, but did not explain how it came about.

In the second phase of development, we focused on aspects of Collective Action. This work focused on identifying and explaining the factors that promote or inhibit work to enact complex interventions in practice. First, this involved the production of a robust applied theoretical model of these factors (May 2006). This was then refined by a larger group of researchers working together (May, et al. 2007a). This theoretical model was then applied: to clinical trials (May, et al. 2007b); to mental health governance processes (Gask, et al. 2008); and telemedicine systems in practice (Finch, et al. 2007; Mair, et al. 2008). An important application of this work was by an international group led by Glyn Elwyn, who used it to develop a strong understanding of problems in the design and application of tools for shared decision-making in the clinical encounter (Elwyn, et al. 2008).

The third phase of theory development has focused on building a middle-range theory that explains how material practices (the things that people do when they operationalise complex healthcare interventions) become routinely embedded in their social contexts. The key paper here was published in Sociology in June 2009 (May and Finch 2009) and can be found here. A pdf presentation that provides an 'Introduction to Normalization Process Theory' can be found here. Other early work applied Normalization Process Theory to explaining the problems of understanding (Finch 2008) and implementing (May 2009a) telemedicine systems, and to the collective work of managing and organizing chronic illness (May 2009b). More recently, NPT has been extended towards a more general theory of implementation (May 2015).

You can also find two papers, written in Italian that you can download (see below).

References cited above

Elwyn, G., Legare, F., Edwards, A., van der Weijden, T. and May, C. 2008 'Arduous implementation: does the normalisation process model explain why it is so difficult to embed decision support technologies in routine clinical practice'Implementation Science 3: 57. 

Finch, T. 2008 'Teledermatology for chronic disease management: coherence and normalization'Chronic Illness 4(2): 127-134. 

Finch, T. L., Mair, F. S. and May, C. R. 2007 'Teledermatology in the UK: lessons in service innovation'British Journal of Dermatology 156(3): 521-527.

Gask, L., Rogers, A., Campbell, S. and Sheaff, R. 2008 'Beyond the limits of clinical governance: the case of mental health in primary careBMC Health Services Research 8: 63 

Mair, F. S., Hiscock, J. and Beaton, S. C. 2008 'Understanding factors that inhibit or promote the utilization of telecare in chronic lung disease'Chronic Illness 4(2): 110-117. 

May C: Towards a general theory of implementation. Implementation Science 2013, 8(1):18.

May, C., Mort, M., Williams, T., Mair, F. S. and Gask, L. 2003a 'Health Technology Assessment in its local contexts: studies of telehealthcare'Social Science and Medicine 57: 697-710. 

May, C. R., Harrison, R., Finch, T., MacFarlane, A., Mair, F. S. and Wallace, P. 2003b 'Understanding the normalization of telemedicine services through qualitative evaluation', Journal of the American Medical Informatics Association 10(6): 596-604.

May, C. 2006 'A rational model for assessing and evaluating complex interventions in health care'BMC Health Services Research 6: 86  

May, C., Finch, T., Mair, F., Ballini, L., Dowrick, C., Eccles, M., Gask, L., MacFarlane, A., Murray, E., Rapley, T., Rogers, A., Treweek, S., Wallace, P., Anderson, G., Burns, J. and Heaven, B. 2007a 'Understanding the implementation of complex interventions in health care: the normalization process model'BMC Health Services Research 7: 148 

May, C. R., Mair, F. S., Dowrick, C. F. and Finch, T. L. 2007b 'Process evaluation for complex interventions in primary care: understanding trials using the normalization process model'BMC Family Practice 8: 42  

May, C. and Finch, T. 2009 'Implementation, embedding, and integration: an outline of Normalization Process Theory'Sociology 43 (3): 535-554 

May, C. 2009a 'Innovation and Implementation in Health Technology: Normalizing Telemedicine', in J. Gabe and M. Calnan (eds) The New Sociology of the Health Service, London: Routledge.  

May, C. 2009b 'Mundane Medicine, Therapeutic Relationships, and the Clinical Encounter.' In  (eds.) ', in B. Pescosolido, J. A. Martin and A. Rogers (eds) Handbook of the Sociology of Health, Illness, and Healing: A Blueprint for the 21st Century, New York: Springer. 

Additional references by method type


Aarts JW, Faber MJ, Cohlen BJ, Van Oers A, Nelen WL, Kremer JA: Lessons learned from the implementation of an online infertility community into an IVF clinic's daily practice. Human Fertility 2015(0):1-10.

Alharbi TS, Carlström E, Ekman I, Olsson L-E: Implementation of person-centred care: management perspective. Journal of Hospital Administration 2014, 3(3):p107.

Atkins S, Lewin S, Ringsberg KC, Thorson A: Provider experiences of the implementation of a new tuberculosis treatment programme: A qualitative study using the normalisation process model. BMC Health Serv Res 2011, 11.

Bamford C, Heaven B, May C, Moynihan P: Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization Process Theory. Implementation Science 2012, 7(1):106.

Bamford C, Poole M, Brittain K, Chew-Graham C, Fox C, Iliffe S, Manthorpe J, Robinson L, team C: Understanding the challenges to implementing case management for people with dementia in primary care in England: a qualitative study using Normalization Process Theory. BMC Health Serv Res 2014, 14(1):549.

Blakeman T, Protheroe J, Chew-Graham C, Rogers A, Kennedy A: Understanding themanagement of early-stage chronic kidney disease in primary care: A qualitative study. Br J Gen Pract 2012, 62(597):e233-e242.

Blickem C, Kennedy A, Jariwala P, Morris R, Bowen R, Vassilev I, Brooks H, Blakeman T, Rogers A: Aligning everyday life priorities with people's self-management support networks: an exploration of the work and implementation of a needs-led telephone support system. BMC Health Serv Res 2014, 14(1):262.

Bouamrane MM, Mair FS: A qualitative evaluation of general practitioners' views on protocol-driven eReferral in Scotland. BMC medical informatics and decision making 2014, 14(1):30.

Bouamrane MM, Mair FS: Implementation of an integrated preoperative care pathway and regional electronic clinical portal for preoperative assessment. BMC medical informatics and decision making 2014, 14(1):93.

Bouamrane M-M, Mair FS: A study of clinical and information management processes in the surgical pre-assessment clinic-The Experience of the Dumfries & Galloway Royal Infirmary Preoperative Clinic. BMC medical informatics and decision making 2014, 14(1):22.

Browne S, Macdonald S, May CR, Macleod U, Mair FS: Patient, carer and professional perspectives on barriers and facilitators to quality care in advanced heart failure. PLoS ONE 2014, 9(3).

Chiang PP, Glance D, Walker J, Walter F, Emery J: Implementing a QCancer risk tool into general practice consultations: an exploratory study using simulated consultations with Australian general practitioners. British journal of cancer 2015, 112:S77-S83.

Clarke DJ, Godfrey M, Hawkins R, Sadler E, Harding G, Forster A, McKevitt C, Dickerson J, Farrin A: Implementing a training intervention to support caregivers after stroke: a process evaluation examining the initiation and embedding of programme change. Implementation science : IS 2013, 8(1):96.

Clarke DJ, Hawkins R, Sadler E, Harding G, McKevitt C, Godfrey M, Dickerson J, Farrin AJ, Kalra L, Smithard D et al: Introducing structured caregiver training in stroke care: findings from the TRACS process evaluation study. BMJ Open 2014, 4(4):e004473.

Coupe N, Anderson E, Gask L, Sykes P, Richards DA, Chew-Graham C: Facilitating professional liaison in collaborative care for depression in UK primary care; A qualitative study utilising normalisation process theory. BMC Fam Pract 2014, 15(1).

Drew S, Judge A, May C, Farmer A, Cooper C, Javaid MK, Gooberman-Hill R: Implementation of secondary fracture prevention services after hip fracture: a qualitative study using extended Normalization Process Theory. Implementation Science 2015, 10(1):57.

Ehrlich C, Kendall E, John WS: How does care coordination provided by registered nurses “fit” within the organisational processes and professional relationships in the general practice context? Collegian 2013, 20(3):127-135.

Finch T: Teledermatology for chronic disease management: coherence and normalization. Chronic Illn 2008, 4(2):127-134.

Finch TL, Bamford C, Deary V, Sabin N, Parry SW: Making sense of a cognitive behavioural therapy intervention for fear of falling: Qualitative study of intervention development. BMC Health Serv Res 2014, 14(1).

Franx G, Oud M, de Lange J, Wensing M, Grol R: Implementing a stepped-care approach in primary care: Results of a qualitative study. Implementation Science 2012, 7(1).

Furler JS, Blackberry ID, Walker C, Manski-Nankervis JA, Anderson J, O'Neal D, Young D, Best J: Stepping up: a nurse-led model of care for insulin initiation for people with type 2 diabetes. Fam Pract 2014, 31(3):349-356.

Gask L, Bower P, Lovell K, Escott D, Archer J, Gilbody S, Lankshear A, Simpson A, Richards D: What work has to be done to implement collaborative care for depression? Process evaluation of a trial utilizing the Normalization Process Model. Implementation science : IS 2010, 5(15):5908-5905.

Gask L, Rogers A, Campbell S, Sheaff R: Beyond the limits of clinical governance? The case of mental health in English primary care. BMC Health Serv Res 2008, 8(1):63.

Godfrey M, Smith J, Green J, Cheater F, Inouye SK, Young JB: Developing and implementing an integrated delirium prevention system of care: a theory driven, participatory research study. BMC Health Serv Res 2013, 13(1):341.

Green T, Martins T, Hamilton W, Rubin G, Elliott K, Macleod U: Exploring GPs’ experiences of using diagnostic tools for cancer: a qualitative study in primary care. Family practice 2014:cmu081.

Hoberg AA, Vickers KS, Ericksen J, Bauer G, Kung S, Stone R, Williams M, Moore MJ, Frye MA: Feasibility evaluation of an interpersonal and social rhythm therapy group delivery model. Archives of psychiatric nursing 2013, 27(6):271-277.

Kennedy A, Rogers A, Bowen R, Lee V, Blakeman T, Gardner C, Morris R, Protheroe J, Chew-Graham C: Implementing, embedding and integrating self-management support tools for people with long-term conditions in primary care nursing: a qualitative study. International journal of nursing studies 2014, 51(8):1103-1113.

Knowles SE, Chew-Graham C, Coupe N, Adeyemi I, Keyworth C, Thampy H, Coventry PA: Better together? a naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems. Implementation science : IS 2013, 8(1):110.

Leon N, Lewin S, Mathews C: Implementing a provider-initiated testing and counselling (PITC) intervention in Cape town, South Africa: A process evaluation using the normalisation process model. Implementation Science 2013, 8(1).

Lhussier M, Forster N, Eaton S, Carr SM: Care planning for long term conditions in primary care: indicators of embeddedness. European Journal for Person Centered Healthcare 2015, 3(1):59-64. 

Ling T, Brereton L, Conklin A, Newbould J, Roland M: Barriers and facilitators to integrating care: Experiences from the English integrated care pilots. Int J Integr Care 2012, 12(JULY-SEPTEMBER 20).

Lloyd A, Joseph-Williams N, Edwards A, Rix A, Elwyn G: Patchy ‘coherence’: using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC). Implementation science : IS 2013, 8(1):102.

Lowrie R, Johansson L, Forsyth P, Bryce SL, McKellar S, Fitzgerald N: Experiences of a community pharmacy service to support adherence and self-management in chronic heart failure. International journal of clinical pharmacy 2014, 36(1):154-162.

Mair FS, Hiscock J, Beaton SC: Understanding factors that inhibit or promote the utilization of telecare in chronic lung disease. Chronic Illn 2008, 4(2):110-117.

McNaughton R, Shucksmith J: Reasons for (non) compliance with intervention following identification of ‘high-risk’status in the NHS Health Check programme. Journal of Public Health 2014:fdu066.

Morden A, Ong BN, Brooks L, Jinks C, Porcheret M, Edwards JJ, Dziedzic KS: Introducing Evidence Through Research “Push” Using Theory and Qualitative Methods. Qualitative health research 2015:1049732315570120.

Morton A, Wigley W: Beyond ‘train and hope’: Identifying factors that affect implementation of the Promotional Guide in practice. Journal of Health Visiting 2014, 2(12):670-680.

Murray E, Burns J, May C, Finch T, O'Donnell C, Wallace P, Mair F: Why is it difficult to implement e-health initiatives? A qualitative study. Implementation Science 2011, 6(1).

Polus BI, Paterson C, Van Rotterdam J, Vindigni D: Embedding chiropractic in Indigenous Health Care Organisations: Applying the normalisation process model. BMC Health Serv Res 2012, 12(1)

Pope C, Halford S, Turnbull J, Prichard J, Calestani M, May C: Using computer decision support systems in NHS emergency and urgent care: ethnographic study using normalisation process theory. BMC Health Serv Res 2013, 13(1):111.

Røsstad T, Garåsen H, Steinsbekk A, Håland E, Kristoffersen L, Grimsmo A: Implementing a care pathway for elderly patients, a comparative qualitative process evaluation in primary care. BMC Health Serv Res 2015, 15(1).

Sanders T, Foster NE, Ong BN: Perceptions of general practitioners towards the use of a new system for treating back pain: A qualitative interview study. BMC Med 2011, 9.

Spangaro J, Poulos RG, Zwi AB: Pandora doesn't live here anymore: Normalization of screening for intimate partner violence in Australian antenatal, mental health, and substance abuse services. Violence Victims 2011, 26(1):130-144.

Stevenson F: The use of electronic patient records for medical research: Conflicts and contradictions. BMC Health Serv Res 2015, 15(1).

Tarzia L, Fetherstonhaugh D, Bauer M, Beattie E, Nay R: " We Have to Work Within the System!": Staff Perceptions of Organizational Barriers to Decision Making for Older Adults With Dementia in Australian Aged Care Facilities. Research in gerontological nursing 2015:1-7.

Trietsch J, van Steenkiste B, Hobma S, Frericks A, Grol R, Metsemakers J, van der Weijden T: The challenge of transferring an implementation strategy from academia to the field: a process evaluation of local quality improvement collaboratives in Dutch primary care using the normalization process theory. Journal of evaluation in clinical practice 2014, 20(6):1162-1171.

Woods E, Gaskell L: The STarT Back Tool: Physiotherapist Experience and Perceptions of its Clinical Utility. European Journal for Person Centered Healthcare 2014, 2(4):497-505.

Mixed methods

Buckingham S, Kendall M, Ferguson S, MacNee W, Sheikh A, White P, Worth A, Boyd K, Murray SA, Pinnock H: HELPing older people with very severe chronic obstructive pulmonary disease (HELP-COPD): mixed-method feasibility pilot randomised controlled trial of a novel intervention. Primary Care Respiratory Medicine 2015, 25.

Gunn JM, Palmer VJ, Dowrick CF, Herrman HE, Griffiths FE, Kokanovic R, Blashki GA, Hegarty KL, Johnson CL, Potiriadis M et al: Embedding effective depression care: Using theory for primary care organisational and systems change. Implementation Science 2010, 5(1).

Henderson EJ, Rubin GP: The utility of an online diagnostic decision support system (Isabel) in general practice: a process evaluation. JRSM short reports 2013, 4(5):31.

Higman W, Wallace LM, Law S, Bartle NC, Blake K: Assessing clinicians' knowledge and confidence to perform kangaroo care and positive touch in a tertiary neonatal unit in England using the Neonatal Unit Clinician Assessment Tool (NUCAT). Journal of Neonatal Nursing 2014.

Hooker L, Small R, Humphreys C, Hegarty K, Taft A: Applying normalization process theory to understand implementation of a family violence screening and care model in maternal and child health nursing practice: a mixed method process evaluation of a randomised controlled trial. Implementation science : IS 2015, 10(1):39.

Jones F, Bailey N: How can we train stroke practitioners about patient self-management? Description and evaluation of a pathway wide training programme. European Journal for Person Centered Healthcare 2013, 1(1):246-254.

Kennedy A, Rogers A, Chew-Graham C, Blakeman T, Bowen R, Gardner C, Lee V, Morris R, Protheroe J: Implementation of a self-management support approach (WISE) across a health system: a process evaluation explaining what did and did not work for organisations, clinicians and patients. Implementation Science 2014, 9(1):129.

Stijnen M, Duimel-Peeters I, Vrijhoel H, Jansen M: Process evaluation plan of a patient-centered home visitation program for potentially frail community-dwelling older people in general practice. European Journal for Person Centered Healthcare 2014, 2(2):179-189.

Thomas LH, French B, Burton CR, Sutton C, Forshaw D, Dickinson H, Leathley MJ, Britt D, Roe B, Cheater FM et al: Evaluating a systematic voiding programme for patients with urinary incontinence after stroke in secondary care using soft systems analysis and Normalisation Process Theory: findings from the ICONS case study phase. International journal of nursing studies 2014, 51(10):1308-1320.

Turnbull J, Prichard J, Halford S, Pope C, Salisbury C: Reconfiguring the emergency and urgent care workforce: mixed methods study of skills and the everyday work of non-clinical call-handlers in the NHS. Journal of health services research & policy 2012, 17(4):233-240

Systematic review

French B, Day E, Watkins C, McLoughlin A, Fitzgerald J, Leathley M, Davies P, Emsley H, Ford G, Jenkinson D et al: The challenges of implementing a telestroke network: A systematic review and case study. BMC Medical Informatics and Decision Making 2013, 13(1).

James D: The applicability of normalisation process theory to speech and language therapy: a review of qualitative research on a speech and language intervention. Implement Sci 2011, 6:95.

Mair, Frances, May, Carl, O'Donnell, Catherine , Finch, Tracy, Sullivan, Frank, and Murray, Elizabeth (2012) Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review. Bulletin of the World Health Organisation, 90. pp. 357-364.

McEvoy R, Ballini L, Malton, S, O’Donnell C, Mair F, MacFarlane A. A qualitative systematic review of studies using the normalization process theory to research implementation processes. Implementation Science 2014, 9:2

Randomised Controlled Trials

Kennedy A, Bower P, Reeves D, Blakeman T, Bowen R, Chew-Graham C, Eden M, Fullwood C, Gaffney H, Gardner C et al: Implementation of self management support for long term conditions in routine primary care settings: cluster randomised controlled trial. Bmj 2013, 346:f2882.

Ong BN, Morden A, Brooks L, Porcheret M, Edwards JJ, Sanders T, Jinks C, Dziedzic K: Changing policy and practice: making sense of national guidelines for osteoarthritis. Soc Sci Med 2014, 106:101-109.

Speed C, Heaven B, Adamson A, Bond J, Corbett S, Lake A, May C, Vanoli A, McMeekin P, Moynihan P: LIFELAX–diet and LIFEstyle versus LAXatives in the management of chronic constipation in older people: randomised controlled trial. Health Technology Assessment 2010, 14(52):1-251.


Mäkelä P, Gawned S, Jones F: Starting early: integration of self-management support into an acute stroke service. BMJ Quality Improvement Reports 2014, 3(1):u202037. w201759

Westbury JA, Johnson MJ, Pond JP, Toy CF, Anderson LS, Blake E, Leaf AA: Developing the role of the nurse as a link advisor for research and a champion for nutrition in the neonatal intensive care unit. Journal of Neonatal Nursing 2013, 19(4):198-205.

Evidence review

de Brún T, de-Brún MOR, van Weel-Baumgarten E, van Weel C, Dowrick C, Lionis C, O’Donnell CA, Burns N, Mair FS, Saridaki A et al: Guidelines and training initiatives that support communication in cross-cultural primary-care settings: appraising their implementability using Normalization Process Theory. Family Practice 2015.

Morriss R: Implementing clinical guidelines for bipolar disorder. Psychology and psychotherapy 2008, 81(Pt 4):437-458.

Reeve J, Blakeman T, Freeman GK, Green LA, James PA, Lucassen P, Martin CM, Sturmberg JP, Van Weel C: Generalist solutions to complex problems: Generating practice-based evidence - The example of managing multi-morbidity. BMC Fam Pract 2013, 14.

Willis K, Small R, Brown S: Using documents to investigate links between implementation and sustainability in a complex community intervention: the PRISM study. Soc Sci Med 2012, 75(7):1222-1229.

Bibliografia - Italiana

Ballini L. L'innovazione nell'implementazione" in  2009 Brunetti M. (editor), L'innovazione nell'assistenza e nuovi strumenti di valutazione. Il Pensiero scientifico editore, Roma 2009 pp. 51-83 Download copy

Ballini L. La 'normalizzazione' degli interventi complessi in sanità Politiche sanitarie, 11, 3 (luglio-settembre 2010) Download copy