Improving the normalization of complex interventions

part 2 - validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT)

Tracy L. Finch (Corresponding Author), Melissa Girling, Carl R. May, Frances Mair, Elizabeth Murray, Shaun Treweek, Elaine McColl, Ian Nicholas Steen, Clare Cook, Christopher Vernazza, Nicola Mackintosh, Samridh Sharma, Gaery Barbery, Jimmy Steele, Tim Rapley

Research output: Contribution to journalArticle

7 Citations (Scopus)
4 Downloads (Pure)

Abstract

Introduction
Successful implementation and embedding of new health care practices relies on co-ordinated, collective behaviour of individuals working within the constraints of health care settings. Normalization Process Theory (NPT) provides a theory of implementation that emphasises collective action in explaining, and shaping, the embedding of new practices. To extend the practical utility of NPT for improving implementation success, an instrument (NoMAD) was developed and validated.

Methods
Descriptive analysis and psychometric testing of an instrument developed by the authors, through an iterative process that included item generation, consensus methods, item appraisal, and cognitive testing. A 46 item questionnaire was tested in 6 sites implementing health related interventions, using paper and online completion. Participants were staff directly involved in working with the interventions. Descriptive analysis and consensus methods were used to remove redundancy, reducing the final tool to 23 items. Data were subject to confirmatory factor analysis which sought to confirm the theoretical structure within the sample.

Results
We obtained 831 completed questionnaires, an average response rate of 39% (range: 22–77%). Full completion of items was 50% (n = 413). The confirmatory factor analysis showed the model achieved acceptable fit (CFI = 0.95, TLI = 0.93, RMSEA = 0.08, SRMR = 0.03). Construct validity of the four theoretical constructs of NPT was supported, and internal consistency (Cronbach’s alpha) were as follows: Coherence (4 items, α = 0.71); Collective Action (7 items, α = 0.78); Cognitive Participation (4 items, α = 0.81); Reflexive Monitoring (5 items, α = 0.65). The normalisation scale overall, was highly reliable (20 items, α = 0.89).

Conclusions
The NoMAD instrument has good face validity, construct validity and internal consistency, for assessing staff perceptions of factors relevant to embedding interventions that change their work practices. Uses in evaluating and guiding implementation are proposed.
Original languageEnglish
Article number135
JournalBMC Medical Research Methodology
Volume18
DOIs
Publication statusPublished - 15 Nov 2018

Fingerprint

Statistical Factor Analysis
Consensus
Delivery of Health Care
Psychometrics
Reproducibility of Results
Health
Surveys and Questionnaires
chemotactic factor inactivator

Keywords

  • normalization process theory
  • NPT
  • NoMAD
  • implementation process
  • questionnaire
  • instrument development
  • complex interventions

Cite this

Improving the normalization of complex interventions : part 2 - validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT) . / Finch, Tracy L. (Corresponding Author); Girling, Melissa; May, Carl R.; Mair, Frances; Murray, Elizabeth; Treweek, Shaun; McColl, Elaine; Steen, Ian Nicholas; Cook, Clare; Vernazza, Christopher; Mackintosh, Nicola; Sharma, Samridh; Barbery, Gaery; Steele, Jimmy; Rapley, Tim.

In: BMC Medical Research Methodology, Vol. 18, 135, 15.11.2018.

Research output: Contribution to journalArticle

Finch, TL, Girling, M, May, CR, Mair, F, Murray, E, Treweek, S, McColl, E, Steen, IN, Cook, C, Vernazza, C, Mackintosh, N, Sharma, S, Barbery, G, Steele, J & Rapley, T 2018, 'Improving the normalization of complex interventions: part 2 - validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT) ', BMC Medical Research Methodology, vol. 18, 135. https://doi.org/10.1186/s12874-018-0591-x
Finch, Tracy L. ; Girling, Melissa ; May, Carl R. ; Mair, Frances ; Murray, Elizabeth ; Treweek, Shaun ; McColl, Elaine ; Steen, Ian Nicholas ; Cook, Clare ; Vernazza, Christopher ; Mackintosh, Nicola ; Sharma, Samridh ; Barbery, Gaery ; Steele, Jimmy ; Rapley, Tim. / Improving the normalization of complex interventions : part 2 - validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT) . In: BMC Medical Research Methodology. 2018 ; Vol. 18.
@article{9512efa6d935413b9940fd0d1fc57d0e,
title = "Improving the normalization of complex interventions: part 2 - validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT)",
abstract = "IntroductionSuccessful implementation and embedding of new health care practices relies on co-ordinated, collective behaviour of individuals working within the constraints of health care settings. Normalization Process Theory (NPT) provides a theory of implementation that emphasises collective action in explaining, and shaping, the embedding of new practices. To extend the practical utility of NPT for improving implementation success, an instrument (NoMAD) was developed and validated.MethodsDescriptive analysis and psychometric testing of an instrument developed by the authors, through an iterative process that included item generation, consensus methods, item appraisal, and cognitive testing. A 46 item questionnaire was tested in 6 sites implementing health related interventions, using paper and online completion. Participants were staff directly involved in working with the interventions. Descriptive analysis and consensus methods were used to remove redundancy, reducing the final tool to 23 items. Data were subject to confirmatory factor analysis which sought to confirm the theoretical structure within the sample.ResultsWe obtained 831 completed questionnaires, an average response rate of 39{\%} (range: 22–77{\%}). Full completion of items was 50{\%} (n = 413). The confirmatory factor analysis showed the model achieved acceptable fit (CFI = 0.95, TLI = 0.93, RMSEA = 0.08, SRMR = 0.03). Construct validity of the four theoretical constructs of NPT was supported, and internal consistency (Cronbach’s alpha) were as follows: Coherence (4 items, α = 0.71); Collective Action (7 items, α = 0.78); Cognitive Participation (4 items, α = 0.81); Reflexive Monitoring (5 items, α = 0.65). The normalisation scale overall, was highly reliable (20 items, α = 0.89).ConclusionsThe NoMAD instrument has good face validity, construct validity and internal consistency, for assessing staff perceptions of factors relevant to embedding interventions that change their work practices. Uses in evaluating and guiding implementation are proposed.",
keywords = "normalization process theory, NPT, NoMAD, implementation process, questionnaire, instrument development, complex interventions",
author = "Finch, {Tracy L.} and Melissa Girling and May, {Carl R.} and Frances Mair and Elizabeth Murray and Shaun Treweek and Elaine McColl and Steen, {Ian Nicholas} and Clare Cook and Christopher Vernazza and Nicola Mackintosh and Samridh Sharma and Gaery Barbery and Jimmy Steele and Tim Rapley",
note = "Funding This study is funded by the Economic and Social Research Council Study [Grant Number RES-062-23-3274] which is gratefully acknowledged. This work was also partially supported by funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 733025, ImpleMentAll project. This content reflects only the author’s view and the European Commission is not responsible for any use that may be made of the information it contains.The Health Services Research Unit, University of Aberdeen, receives core funding from the Chief Scientist Office of the Scottish Government Health Directorates. CRV was funded by a Clinician Scientist award supported by the National Institute for Health Research during this independent research. Availability of data and materials The datasets generated and/or analysed during the current study are deposited on UK Datashare (record 852,387). Further information is available from the corresponding author on reasonable request.",
year = "2018",
month = "11",
day = "15",
doi = "10.1186/s12874-018-0591-x",
language = "English",
volume = "18",
journal = "BMC Medical Research Methodology",
issn = "1471-2288",
publisher = "BioMed Central",

}

TY - JOUR

T1 - Improving the normalization of complex interventions

T2 - part 2 - validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT)

AU - Finch, Tracy L.

AU - Girling, Melissa

AU - May, Carl R.

AU - Mair, Frances

AU - Murray, Elizabeth

AU - Treweek, Shaun

AU - McColl, Elaine

AU - Steen, Ian Nicholas

AU - Cook, Clare

AU - Vernazza, Christopher

AU - Mackintosh, Nicola

AU - Sharma, Samridh

AU - Barbery, Gaery

AU - Steele, Jimmy

AU - Rapley, Tim

N1 - Funding This study is funded by the Economic and Social Research Council Study [Grant Number RES-062-23-3274] which is gratefully acknowledged. This work was also partially supported by funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 733025, ImpleMentAll project. This content reflects only the author’s view and the European Commission is not responsible for any use that may be made of the information it contains.The Health Services Research Unit, University of Aberdeen, receives core funding from the Chief Scientist Office of the Scottish Government Health Directorates. CRV was funded by a Clinician Scientist award supported by the National Institute for Health Research during this independent research. Availability of data and materials The datasets generated and/or analysed during the current study are deposited on UK Datashare (record 852,387). Further information is available from the corresponding author on reasonable request.

PY - 2018/11/15

Y1 - 2018/11/15

N2 - IntroductionSuccessful implementation and embedding of new health care practices relies on co-ordinated, collective behaviour of individuals working within the constraints of health care settings. Normalization Process Theory (NPT) provides a theory of implementation that emphasises collective action in explaining, and shaping, the embedding of new practices. To extend the practical utility of NPT for improving implementation success, an instrument (NoMAD) was developed and validated.MethodsDescriptive analysis and psychometric testing of an instrument developed by the authors, through an iterative process that included item generation, consensus methods, item appraisal, and cognitive testing. A 46 item questionnaire was tested in 6 sites implementing health related interventions, using paper and online completion. Participants were staff directly involved in working with the interventions. Descriptive analysis and consensus methods were used to remove redundancy, reducing the final tool to 23 items. Data were subject to confirmatory factor analysis which sought to confirm the theoretical structure within the sample.ResultsWe obtained 831 completed questionnaires, an average response rate of 39% (range: 22–77%). Full completion of items was 50% (n = 413). The confirmatory factor analysis showed the model achieved acceptable fit (CFI = 0.95, TLI = 0.93, RMSEA = 0.08, SRMR = 0.03). Construct validity of the four theoretical constructs of NPT was supported, and internal consistency (Cronbach’s alpha) were as follows: Coherence (4 items, α = 0.71); Collective Action (7 items, α = 0.78); Cognitive Participation (4 items, α = 0.81); Reflexive Monitoring (5 items, α = 0.65). The normalisation scale overall, was highly reliable (20 items, α = 0.89).ConclusionsThe NoMAD instrument has good face validity, construct validity and internal consistency, for assessing staff perceptions of factors relevant to embedding interventions that change their work practices. Uses in evaluating and guiding implementation are proposed.

AB - IntroductionSuccessful implementation and embedding of new health care practices relies on co-ordinated, collective behaviour of individuals working within the constraints of health care settings. Normalization Process Theory (NPT) provides a theory of implementation that emphasises collective action in explaining, and shaping, the embedding of new practices. To extend the practical utility of NPT for improving implementation success, an instrument (NoMAD) was developed and validated.MethodsDescriptive analysis and psychometric testing of an instrument developed by the authors, through an iterative process that included item generation, consensus methods, item appraisal, and cognitive testing. A 46 item questionnaire was tested in 6 sites implementing health related interventions, using paper and online completion. Participants were staff directly involved in working with the interventions. Descriptive analysis and consensus methods were used to remove redundancy, reducing the final tool to 23 items. Data were subject to confirmatory factor analysis which sought to confirm the theoretical structure within the sample.ResultsWe obtained 831 completed questionnaires, an average response rate of 39% (range: 22–77%). Full completion of items was 50% (n = 413). The confirmatory factor analysis showed the model achieved acceptable fit (CFI = 0.95, TLI = 0.93, RMSEA = 0.08, SRMR = 0.03). Construct validity of the four theoretical constructs of NPT was supported, and internal consistency (Cronbach’s alpha) were as follows: Coherence (4 items, α = 0.71); Collective Action (7 items, α = 0.78); Cognitive Participation (4 items, α = 0.81); Reflexive Monitoring (5 items, α = 0.65). The normalisation scale overall, was highly reliable (20 items, α = 0.89).ConclusionsThe NoMAD instrument has good face validity, construct validity and internal consistency, for assessing staff perceptions of factors relevant to embedding interventions that change their work practices. Uses in evaluating and guiding implementation are proposed.

KW - normalization process theory

KW - NPT

KW - NoMAD

KW - implementation process

KW - questionnaire

KW - instrument development

KW - complex interventions

U2 - 10.1186/s12874-018-0591-x

DO - 10.1186/s12874-018-0591-x

M3 - Article

VL - 18

JO - BMC Medical Research Methodology

JF - BMC Medical Research Methodology

SN - 1471-2288

M1 - 135

ER -