Applying Structural Equation Modelling to Understand the Implementation of Social Distancing in the Professional Lives of Healthcare Workers.

This study, based on the normalization process theory (NPT), explores the implementation of nonpharmaceutical interventions (NPIs)-specifically social distancing (SD)-in the professional lives of healthcare workers in three Pakistani hospitals. We collected and analysed health workers' data using partial least squares structural equation modelling (PLS-SEM) and assessed the policy implications of the results. Violations of normality assumptions in the quantitative data and the need for scores of independent variables for follow-up analysis guided the researchers to adopt a structural equation modelling process that involved a stepwise evaluation process for convergent validity, individual item validity, discriminant validity, the structural model relationship, and overall model fitness. Theoretical constructs coherence, cognitive participation, collective action, and reflexive monitoring were found to influence the normalization of SD. The results show that SD was normalized in the professional lives of healthcare workers through strong collective action (resources required) and reflexive monitoring (appraisal) but weak cognitive participation (actors' engagement) and coherence (sense-making). Low and middle-income countries (LMICs) should work more on actors' sense-making and engagement in dealing with healthcare crises that require SD. The research findings can aid policy institutions in better understanding the loopholes in the implementation process and making better policies.