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Implementation Science
Published in: Implementation Science 1/2013

Open Access 01-12-2013 | Study protocol

Improving the normalization of complex interventions: measure development based on normalization process theory (NoMAD): study protocol

Authors: Tracy L Finch, Tim Rapley, Melissa Girling, Frances S Mair, Elizabeth Murray, Shaun Treweek, Elaine McColl, Ian Nicholas Steen, Carl R May

Published in: Implementation Science | Issue 1/2013

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Abstract

Background

Understanding implementation processes is key to ensuring that complex interventions in healthcare are taken up in practice and thus maximize intended benefits for service provision and (ultimately) care to patients. Normalization Process Theory (NPT) provides a framework for understanding how a new intervention becomes part of normal practice. This study aims to develop and validate simple generic tools derived from NPT, to be used to improve the implementation of complex healthcare interventions.

Objectives

The objectives of this study are to: develop a set of NPT-based measures and formatively evaluate their use for identifying implementation problems and monitoring progress; conduct preliminary evaluation of these measures across a range of interventions and contexts, and identify factors that affect this process; explore the utility of these measures for predicting outcomes; and develop an online users’ manual for the measures.

Methods

A combination of qualitative (workshops, item development, user feedback, cognitive interviews) and quantitative (survey) methods will be used to develop NPT measures, and test the utility of the measures in six healthcare intervention settings.

Discussion

The measures developed in the study will be available for use by those involved in planning, implementing, and evaluating complex interventions in healthcare and have the potential to enhance the chances of their implementation, leading to sustained changes in working practices.
Literature
1.
Pope C: Resisting evidence: the study of evidence-based medicine as a contemporary social movement. Health. 2003, 7 (3): 267-282.
2.
Whitten P, Collins B: The diffusion of telemedicine: communicating an innovation. Sci Commun. 1997, 19 (1): 21-40. 10.1177/1075547097019001002.CrossRef
3.
Kuhlmann E, Burau V: The ‘healthcare state’ in transition - national and international contexts of changing professional governance. Eur Soc. 2008, 10 (4): 619-633. 10.1080/14616690701871886.CrossRef
4.
Woolf SH: The meaning of translational research and why it matters. JAMA. 2008, 299 (2): 211-213. 10.1001/jama.2007.26.CrossRefPubMed
5.
Grol RPTM, Bosch MC, Hulscher MEJL: Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q. 2007, 85 (1): 93-138. 10.1111/j.1468-0009.2007.00478.x.CrossRefPubMedPubMedCentral
6.
Rogers EM: The diffusion of innovation. 1995, New York: Free Press, 4
7.
Webster A: Health, technology and society: a sociological critique. 2007, Basingstoke: Palgrave Macmillan
8.
Rogers EM: A prospective and retrospective look at the diffusion model. J Health Commun. 2004, 9: 13-19. 10.1080/10810730490271449.CrossRefPubMed
9.
Presseau J, Sniehotta FF, Francis JJ, Campbell NC: Multiple goals and time constraints: perceived impact on physicians’ performance of evidence-based behaviours. Implement Sci. 2009, 4: 77-10.1186/1748-5908-4-77.CrossRefPubMedPubMedCentral
10.
11.
May C, Mair F, Finch T, MacFarlane A, Dowrick C, Treweek S, Rapley T, Ballini L, Ong BN, Rogers A, Murray E, Elwyn G, Légaré F, Gunn J, Montori V: Development of a theory of implementation and integration: normalization process theory. Implement Sci. 2009, 4 (29): 10.1186/1748-5908-4-29.
12.
May C, Finch T: Implementing, integrating and embedding practices: an outline of normalization process theory. Sociology. 2009, 43 (3): 535-54.CrossRef
13.
May C, Finch T, Mair F: Understanding the implementation of complex interventions in health care: the normalization process model. BMC Health Serv Res. 2007, 7 (148): 10.1186/1472-6963-7-148.
14.
May CR, Mair FS, Dowrick CF: Process evaluation for complex interventions in primary care: understanding trials using the normalization process model. BMC Fam Pract. 2007, 8: 10.1186/1471-2296-8-42.
15.
May C, Finch T, Cornford J: Integrating telecare for chronic disease management in the community: what needs to be done?. 2010, London: NIHR
16.
Mair F, May C, Murray E: Understanding the implementation and integration of E-health services. 2009, London: National Co-ordinating Centre for the National Institute for Health Research Service Delivery and Organisation Programme (NCCSDO)
17.
Mair F, May C, O’Donnell C: Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review. Bulletin World Health Organisation. 2012, 90 (5): 357-364. 10.2471/BLT.11.099424.CrossRef
18.
Gunn J, Kokanovic R, Palmer V: Re-organising the care of depression and other related disorders in the Australian primary health care setting. 2009, Canberra: Australian Primary Health Care Research Institute
19.
Pencille LJ, Campbell ME, Van Houten HK: Protocol for the osteoporosis choice trial. A pilot randomized trial of a decision aid in primary care practice. Trials. 2009, 10: 9-10.1186/1745-6215-10-113.CrossRef
20.
Elwyn GLF, van der Weijden T, Edwards A, May C: Arduous implementation: does the normalisation process model explain why it’s so difficult to embed decision support technologies for patients in routine clinical practice?. Implement Sci. 2008, 3: 57-10.1186/1748-5908-3-57.CrossRefPubMedPubMedCentral
21.
Finch T, Mair F, O’Donnell C: From theory to ‘measurement’ in complex interventions: methodological lessons from the development of an e-health normalisation instrument. BMC Med Res Methodol. 2012, 12 (1): 69-10.1186/1471-2288-12-69.CrossRefPubMedPubMedCentral
22.
Murray EMC, Mair F: Development and formative evaluation of the e-health implementation toolkit (e-HIT). BMC Med Inform Decis Mak. 2010, 10 (1): 61-10.1186/1472-6947-10-61.CrossRefPubMedPubMedCentral
23.
May C, Finch T, Ballini L: Evaluating complex interventions and health technologies using normalization process theory: development of a simplified approach and web-enabled toolkit. BMC Health Serv Res. 2011, 11 (1): 245-10.1186/1472-6963-11-245.CrossRefPubMedPubMedCentral
24.
Murray E, Treweek S, Pope C: Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med. 2010, 8 (1): 63-10.1186/1741-7015-8-63.CrossRefPubMedPubMedCentral
25.
MacFarlane A, O’Donnell C, Mair F: REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings (RESTORE): study protocol. Implement Sci. 2012, 7 (1): 111-10.1186/1748-5908-7-111.CrossRefPubMedPubMedCentral
26.
Snyder RA, Fields WL: Measuring hospital readiness for information technology(IT) innovation: a multisite study of the organizational information technology innovation readiness scale. J Nurs Meas. 2006, 14 (1): 45-55. 10.1891/jnum.14.1.45.CrossRefPubMed
27.
Willis GB, Lessler JT: Guidelines for designing and evaluating questionnaires. 1999, Rockville, MD: Research Triangle Institute
28.
Lessler JT, Forsyth BH: A coding system for appraising questionnaires. Answering questions: methodology for determining cognitive and communicative processes in survey research. Edited by: Schwarz N, Sudman S. 1996, San Francisco: Jossey-Bass, 389-402.
29.
Graesser A, Wiemer-hastings K, Kreuz R: QUAID: a questionnaire evaluation aid for survey methodologists. Behav Res Methods. 2000, 32 (2): 254-62. 10.3758/bf03207792.CrossRef
30.
Willis GB: Cognitive interviewing: A tool for improving questionnaire design. 2005, California: Sage Publications Inc.CrossRef
31.
Knafl K, Deatrick J, Gallo A: The analysis and interpretation of cognitive interviews for instrument development. Res Nurs Health. 2007, 30 (2): 224-234. 10.1002/nur.20195.CrossRefPubMed
32.
Edwards P, Roberts I, Clarke M: Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev. 2009, 10.1002/14651858.MR000008.pub4. Art. No.: MR000008, 3CrossRef
33.
Nunnally JC: Pyschometric Theory. 2nd Edition ed. 1978, New York: McGraw-Hill
34.
Ajzen I: The theory of planned behavior. Organ Behav Hum Decis Process. 1991, 50: 179-211. 10.1016/0749-5978(91)90020-T.CrossRef
35.
Francis JJ, Eccles MP, Johnston M: Constructing questionnaires based on the Theory of Planned Behavior - A manual for health services researchers. Newcastle upon. 2004, Tyne, England: Centre for Health Services Research Newcastle University
36.
Atkins S, Lewin S, Ringsberg KC: Provider experiences of the implementation of a new tuberculosis treatment programme: A qualitative study using the normalisation process model. BMC Health Serv Res. 2011, 11 (1): 275-10.1186/1472-6963-11-275.CrossRefPubMedPubMedCentral
37.
Blakeman T, Protheroe J, Chew-Graham C: Understanding the management of early-stage chronic kidney disease in primary care: a qualitative study. Br J Gen Pract. 2012, 62 (597): 10.3399/bjgp12X636056. e233-e42
38.
Elwyn G, Légaré F, Weijden T: Arduous implementation: does the normalisation process model explain why it’s so difficult to embed decision support technologies for patients in routine clinical practice. Implement Sci. 2008, 3 (1): 57-10.1186/1748-5908-3-57.CrossRefPubMedPubMedCentral
39.
Forster DA, Newton M, McLachlan HL: Exploring implementation and sustainability of models of care: can theory help?. BMC Publ Health. 2011, 11 (5): S8-10.1186/1471-2458-11-s5-s8.CrossRef
40.
Foy R, Ovretveit J, Shekelle PG: The role of theory in research to develop and evaluate the implementation of patient safety practices. BMJ Quality & Safety. 2011, 20 (5): 453-59. 10.1136/bmjqs.2010.047993.CrossRef
41.
Franx G, Oud M, de Lange J: Implementing a stepped-care approach in primary care: results of a qualitative study. Implement Sci. 2012, 7 (1): 8-10.1186/1748-5908-7-8.CrossRefPubMedPubMedCentral
42.
Gallacher K, May CR, Montori VM: Understanding Patients’ experiences of treatment burden in chronic heart failure using normalization process theory. Ann Fam Med. 2011, 9 (3): 235-43. 10.1370/afm.1249.CrossRefPubMedPubMedCentral
43.
Gask L, Bower P, Lovell K, Gask L, Bower P, Lovell K: What work has to be done to implement collaborative care for depression?Process evaluation of a trial utilizing the Normalization Process Model. Implement Sci. 2010, 5 (15): 10.1186/1748-5908-5-15.
44.
Gask L, Rogers A, Campbell S: Beyond the limits of clinical governance? The case of mental health in English primary care. BMC Health Serv Res. 2008, 8 (1): 63-10.1186/1472-6963-8-63.CrossRefPubMedPubMedCentral
45.
Gunn JM, Palmer VJ, Dowrick CF: Embedding effective depression care: using theory for primary care organisational and systems change. Implement Sci. 2010, 5 (1): 62-10.1186/1748-5908-5-62.CrossRefPubMedPubMedCentral
46.
James DM: The applicability of normalisation process theory to speech and language therapy: a review of qualitative research on a speech and language intervention. Implement Sci. 2011, 6 (1): 95-10.1186/1748-5908-6-95.CrossRefPubMedPubMedCentral
47.
Kennedy A, Chew-Graham C, Blakeman T: Delivering the WISE (Whole Systems Informing Self-Management Engagement) training package in primary care: learning from formative evaluation. Implement Sci. 2010, 5 (1): 7-10.1186/1748-5908-5-7.CrossRefPubMedPubMedCentral
48.
MacFarlane A, O’Reilly-de Brun M: Using a theory-driven conceptual framework in qualitative health research. Qualitative Health Research (QUAL.HEALTH RES.). 2011, 22 (5): 607-18. 10.1177/1049732311431898. 1998. May; 8.(3): 341.51.(32.ref)CrossRef
49.
Mair FS, Hiscock J, Beaton SC: Understanding factors that inhibit or promote the utilization of telecare in chronic lung disease. Chronic Illn. 2008, 4 (2): 110-17. 10.1177/1742395308092482.CrossRefPubMed
50.
Murray E, Burns J, May C: Why is it difficult to implement e-health initiatives? A qualitative study. Implement Sci. 2011, 6 (1): 6-10.1186/1748-5908-6-6.CrossRefPubMedPubMedCentral
51.
Rogers A, Vassilev I, Sanders C: Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support. Implement Sci. 2011, 6 (1): 56-10.1186/1748-5908-6-56.CrossRefPubMedPubMedCentral
52.
Sanders T, Foster NE, Ong B: Perceptions of general practitioners towards the use of a new system for treating back pain: a qualitative interview study. BMC Med. 2011, 9 (1): 49-10.1186/1741-7015-9-49.CrossRefPubMedPubMedCentral
53.
Sooklal R, Papadopoulos T, Ojiako U: Information systems development: a normalisation process theory perspective. Industrial Management & Data Systems. 2011, 111 (8): 1270-86. 10.1108/02635571111170794.CrossRef
54.
Wilkes S, Rubin G: Process evaluation of infertility management in primary care: has open access HSG been normalized?. Primary Health Care Research & Development. 2009, 10: 290-298. 10.1017/S1463423609990168.CrossRef
Metadata
Title
Improving the normalization of complex interventions: measure development based on normalization process theory (NoMAD): study protocol
Authors
Tracy L Finch
Tim Rapley
Melissa Girling
Frances S Mair
Elizabeth Murray
Shaun Treweek
Elaine McColl
Ian Nicholas Steen
Carl R May
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2013
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-8-43

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