Cognitive Participation is the relational work that people do to build and sustain a community of practice around a new technology or complex intervention. Like all NPT constructs, it has four components.
2.1 Initiation: When a set of practices is new or modified, a core problem is whether or not key participants are working to drive them forward. For example, the work of setting up a clinical service is often delegated to a small group of managers and professionals who are charged with the work of setting up systems, procedures, and protocols and engaging with others to make things happen.
2.2 Enrolment: Participants may need to organize or reorganize themselves and others in order to collectively contribute to the work involved in new practices. This is complex work that may involve rethinking individual and group relationships between people and things. For example, getting nurses to 'buying in' to a falls prevention strategy is vital to its success, but the work of buying in to the strategy is not simply about individual commitment, but is about building communal engagement.
2.3 Legitimation: An important component of relational work around participation is the work of ensuring that other participants believe it is right for them to be involved, and that they can make a valid contribution to it. New service interventions often founder because of a lack of investment in ensuring that they fit with the ways that different groups of professionals - and sometimes patients - define their possible contribution to them.
2.4 Activation: Once it is underway, participants need to collectively define the actions and procedures needed to sustain a practice and to stay involved.In fact, staying on the case is vital to sustaining clinical interventions. This is the work of keeping the new practices in view and connecting them with the people who need to be doing them