From theory to practice: using the Normalization Process Theory and Theoretical Domains Framework to understand implementation of decarbonization in general practice

Nunes, Ana Raquel; Atherton, Helen; Dahlmann, Frederik; Eccles, Abi; Geddes, Olivia; Gregg, Michael; Karaba, Florence; Spencer, Rachel; Twohig, Helen; Dale, Jeremy

Abstract

Background: Decarbonization in general practice is a critical step toward achieving a net zero healthcare system. Understanding the factors that facilitate or hinder the implementation of environmentally sustainable practices is essential for effective and equitable action. Hence, the overarching aim of this study is to advance understanding of the factors influencing decarbonization in general practice. This study’s objective is to map and compare the application of the Normalization Process Theory (NPT) and Theoretical Domains Framework (TDF) in understanding the key factors and sub-factors related to decarbonization in general practice. Methods: Factors derived from a systematic review and narrative synthesis were mapped to NPT constructs and TDF domains by a multidisciplinary team of 10 coders, including academic general practitioners (GPs), researchers, and patient representatives. The mapping was conducted independently, and coder agreement was evaluated for consistency and reliability in categorization. Results: The study identifies key NPT (‘Coherence’, ‘Collective Action’, and ‘Cognitive Participation’) and TDF domains (‘Environmental Context and Resources’, ‘Knowledge’, and ‘Social/professional role and identity’) associated with factors identified in previous research as being associated with achieving decarbonization in general practice. A high intercoder reliability rate (73% for NPT, 84% for TDF) supports the consistency of the analysis, particularly for structured drivers such as financial incentives and policy support. Conclusions: The findings demonstrate that the NPT and TDF frameworks provide useful, though incomplete, insights into factors influencing decarbonization in general practice. Such factors require more attention when developing evidence-based strategies for promoting decarbonization, something that future research could evaluate.

Citation

Nunes, A. R., Atherton, H., Dahlmann, F., Eccles, A., Geddes, O., Gregg, M., Karaba, F., Spencer, R., Twohig, H., & Dale, J. (2025). From theory to practice: using the Normalization Process Theory and Theoretical Domains Framework to understand implementation of decarbonization in general practice. Family Practice, 42(4), cmaf050. https://doi.org/10.1093/fampra/cmaf050

• Journal Article Type: Article
• Acceptance Date: Jun 6, 2025
• Online Publication Date: Jul 2, 2025
• Publication Date: Jul 2, 2025
• Deposit Date: Jun 19, 2025
• Publicly Available Date: Jul 2, 2025
• Journal: Family Practice
• Print ISSN: 0263-2136
• Electronic ISSN: 1460-2229
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 42
• Issue: 4
• Article Number: August 2025
• Pages: cmaf050
• DOI: https://doi.org/10.1093/fampra/cmaf050
• Keywords: decarbonization, climate action, planetary health, environmental sustainability, net zero healthcare, emissions reduction, sustainability, behaviour change
• Public URL: https://keele-repository.worktribe.com/output/1278920
• Publisher URL: https://academic.oup.com/fampra/article/42/4/cmaf050/8180937