Page - 179 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

for example, if during collective action some feedback from a staff member indicates a significant area that the intervention is likely to affect, that was unlikely to be picked up by processes relating to reflexive monitoring, this could lead to changes in the programme design. Finally, we may simply see gradual changes made to the work of implementing interventions, which would come under collective action, because of findings related to reflexive monitoring. What these indicate is that implementation processes identified by the constructs may not proceed in a strictly linear fashion but encounter difficulties and go through revisions as they evolve. 1.7 From implementation to normalization – embedding new practices as routine aspects of care. We began this section by noting that NPT focused on action, and we will conclude with an example indicating the importance of this for implementation in general. Figure 1 shows results from an investigation (a theory-led review) of systematic reviews into professional behaviour change in healthcare [9]. Along the topof this matrixwe can see the NPT constructs and components, while the left-hand vertical distribution shows different types of professional intervention as defined by the Cochrane EPOC (Effective Practice and Organisation of Care) system. Studies in the review have been grouped by type, and each group has been ranked in terms of their success at effecting and sustaining professional behaviour change. The red boxes indicate which components of NPT were covered by the intervention, and these show a positive association between success of interventions, and their emphasis on the collective action and reflexive monitoring aspects of the intervention. On the basis of this, the review authors hypothesise that interventions which focus on attitudinal change are less likely to be effective in achieving long term behaviour change than those that reinforce new practice norms and associate them with peer and reference group behaviours [9]. Changing attitudes and building value are necessary activities, but may not suffice to ensure long-term success. Figure 1 - Positive relationship between intervention effectiveness and focus on Collective action and Reflexive monitoring aspects of NPT [9]. M.BracherandC.R.May / ImplementingandEmbeddingHealth InformaticsSystems 179