al give the example of the ImPACT back pain trial (Tooth et al, 2009) where the
researchers discovered that in the context of a consultation back pain was rarely
the primary complaint of the patient.
As a result GPs did not place importance on
discussing back pain and making referrals, this low coherence lead to low
cognitive engagement and low participation.
Having defined the context, the next stage is to define the intervention.
NPT concepts once again occur at each of the first three stages including
differentiation, enrolment and skillset workability (the reflexive monitoring stage
was purposefully omitted from this list as evaluation will be discussed in detail
later in this chapter).
The NPT sensitises the researcher to issues around how the
intervention must be perceived as different from practices, while fitting with the
current context and how the necessary people must be organised and trained in
line with current roles and strengths.
Once both context and intervention are defined, an NPT evaluation of the
intervention can take place.
In the “trial killer” paper Murray and colleagues
(2010) put forward a series of questions developed from the NPT to offer a
framework to decide whether the new intervention is likely to be effectively
normalised in the given context.
These questions cover each of the concepts of
For example, a question to address differentiation from the concept of
“Is the intervention clearly distinct from other interventions?”
question addressing contextual integration from the concept of collective action is
“How compatible is it with existing practices?”
To address these questions, a
combination of the previous literature and primary data is likely to be required, in
doing this the NPT can sensitise researchers to the requirements of new
interventions if they are to become normalised in complex contexts such as
primary care where the new intervention must both fit with current practices
while being a distinct practice, and where people must be effectively engaged and
remain engaged in order for the new intervention to compete effectively for