. 2020 May 7;20:387. doi: 10.1186/s12913-020-05234-1

Table 2.

Summary of results using the Normalization process theory coding framework

Coherence	Cognitive participation	Collective action	Reflexive monitoring
Differentiation: Staff in all sites understood that the digital feedback system differed from existing practice. Patients/social networks also saw this difference.	Enrolment: Buy-in from senior staff existed but this was not necessarily the case amongst staff who had to implement or support the change.	Skill set workability: Most staff did not feel that their roles and responsibilities were affected.	Reconfiguration: Spatial changes were made in several sites to make the kiosk more visible. Alternatives to the keyboard were also introduced.
Communal specification: Shared understanding amongst staff varied between sites. Senior staff and data analysts had greatest understanding.	Activation: Continued involvement was strongest in sites A and C2.	Contextual Integration: Organizational support was highest in site A and C2. The context in site C2 for continuous feedback loops and PPG involvement strengthened implementation. Initial support in site C1 was adversely affected by the major organisational changes.	Communal appraisal: Potential benefits were recognised, but the study was not able to collect longer term views.
Individual specification: Agreement about tasks and responsibilities in the implementation of the new approach was variable across sites with most clear agreement in site C2.	Initiation: Site 2 had a lead GP and practice manager as key drivers. Site A had senior management support but grassroots staff did not always feel connected. In site B initial commitment was high but organisational change and turbulence reduced this.	Interactional workability: Staff with data analysis responsibilities felt that the new approach would ease their work. Grassroots staff were concerned that supporting patients to use the digital kiosk would add to their workload.	Individual appraisal; Lasting effects on individuals and their work environment are not yet discernible.
Internalization: The potential value of digital feedback was understood by staff, patients/social networks.	Legitimation: Staff differed in their belief that supporting digital feedback was part of their role. Patients/social networks were at times hampered by their lack of confidence to engage with digital tools.	Relational integration: Staff confidence in the new system was adversely affected by technical hitches. Patients’ confidence depended on their own digital skills and physical ability to operate the keyboard.	Systematization: Benefits in terms of quicker data analysis are recognised. Longer term benefits may be identified in the future.

Coherence

Cognitive participation

Collective action

Reflexive monitoring

Differentiation:

Staff in all sites understood that the digital feedback system differed from existing practice. Patients/social networks also saw this difference.

Enrolment:

Buy-in from senior staff existed but this was not necessarily the case amongst staff who had to implement or support the change.

Skill set workability:

Most staff did not feel that their roles and responsibilities were affected.

Reconfiguration:

Spatial changes were made in several sites to make the kiosk more visible. Alternatives to the keyboard were also introduced.

Communal specification:

Shared understanding amongst staff varied between sites. Senior staff and data analysts had greatest understanding.

Activation:

Continued involvement was strongest in sites A and C2.

Contextual Integration:

Organizational support was highest in site A and C2. The context in site C2 for continuous feedback loops and PPG involvement strengthened implementation. Initial support in site C1 was adversely affected by the major organisational changes.

Communal appraisal:

Potential benefits were recognised, but the study was not able to collect longer term views.

Individual specification: Agreement about tasks and responsibilities in the implementation of the new approach was variable across sites with most clear agreement in site C2.

Initiation:

Site 2 had a lead GP and practice manager as key drivers. Site A had senior management support but grassroots staff did not always feel connected. In site B initial commitment was high but organisational change and turbulence reduced this.

Interactional workability:

Staff with data analysis responsibilities felt that the new approach would ease their work. Grassroots staff were concerned that supporting patients to use the digital kiosk would add to their workload.

Individual appraisal; Lasting effects on individuals and their work environment are not yet discernible.

Internalization:

The potential value of digital feedback was understood by staff, patients/social networks.

Legitimation:

Staff differed in their belief that supporting digital feedback was part of their role. Patients/social networks were at times hampered by their lack of confidence to engage with digital tools.

Relational integration:

Staff confidence in the new system was adversely affected by technical hitches. Patients’ confidence depended on their own digital skills and physical ability to operate the keyboard.

Systematization:

Benefits in terms of quicker data analysis are recognised. Longer term benefits may be identified in the future.