Table 2 Use of the normalisation process theory (NPT) topic guide for interview/survey questions
NPT component | Example question topics |
|---|---|
Coherence | |
 Differentiation    How a set of practice differs from each other | 1. The relationship between knowing FoR is an area of concern and identifying how a new intervention aligns with everyday practice 2. The worth attributed to introducing a FoR intervention 3. Is the intervention easy to describe? 4. Is it different from other interventions? 5. Is there a shared sense of purpose to address FoR among women with breast cancer? 6. Who would the intervention benefit (thinking more broadly)? Interview: Whose responsibility is it to discuss FoR? Is there a shared sense of purpose to address FoR among breast cancer patients? How do you think the Mini-AFTER differs to your current method of assessing patients for FoR 7. Are the benefits likely to be valued by women with breast cancer? 8. Will an intervention fit with the overall goals and activity of the organisation where the BCN works? Interview: Can you envisage the Mini-AFTER changing your practice? |
 Communal specification    Working together to build a shared understanding of the aims, objectives and benefits of a way of working | |
 Individual specification    Understanding specific tasks and responsibilities around a set of practice | |
 Internationalisation    Understanding the value, benefit and importance of a set of practices | |
Cognitive participation | |
 Initiation    A core problem and whether or not key participants are driving it forward | 1. Are BCNs likely to think it is a good idea? 2. Can they see the point of the intervention easily? Interview: Would you be willing to invest time to attain competence? 3. What kind of skills do BCNs have when dealing with FoR now? Survey: See Table 2 ver2 4. Will they be prepared to invest time, energy and work in it? Survey: See Table 2 ver2 This includes: • Training – examples giving in the survey • Attaining competence to deliver intervention • Time to deliver intervention • Invest in changing practice environment |
 Enrolment    May need to organise or reorganise themselves – rethinking relationships | |
 Legitimisation    The belief that an individual can make a contribution | |
 Activation    Identify and define the actions and procedures required to sustain a new practice | |
Collective action | |
 Interactional workability   Work people do with each other and the other elements of their practices to enable them to operationalise it | 1. How will providing a specific intervention affect the work of the BCN? Interview: How would Mini-AFTER impact your workload Interview: Would Mini-AFTER promote or impede your work? 2. Do they think it would promote or impede their work? 3. What effect will it have on the support they offer to women? 4. Do they think it would change the patient/BCN relationship? 5. Is the work compatible with their existing work practices? Survey: Questions understanding current working practices 6. How would the addition of an intervention impact on their workload and that of their colleagues? 7. What impact will there be on resources such as time? 8. How does it fit with the overall goals of their organisation/wider policy agenda? |
 Relational integration    The knowledge that participants have to build accountability and mental confidence in the new intervention | |
 Skill set workability    Allocation of work – who gets to do work in the trial | |
 Contextual integration    Allocation of resources to ensure the intervention can be fully executed in practice | |
Reflexive monitoring | |
 Systematisation    Individuals may seek to determine how effective and useful it is for them and others | 1. Perceptions of benefit to patients or staff 2. What may be required to make the intervention workable in practice? 3. When would be an appropriate time to review the intervention? 4. Do they perceive issues associated with recruitment? |
 Communal appraisal    Participants together (formally and informally) to evaluate the worth of a set of practices – Is it working? | |
 Individual approval    Work experientially as individuals, its effects on them and the context (an intervention that complicates and demands workload may well have low uptake even if beneficial to patient) | |
 Reconfiguration    Modifying or redefining a practice to make it workable in practice | |