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

Finch, T. L. et al. (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, 18, 135. (doi: 10.1186/s12874-018-0591-x) (PMID:30442094) (PMCID:PMC6238372)

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.

• Item Type: Articles
• Additional Information: 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.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Finch, Dr Tracy and Mair, Professor Frances
• Authors: Finch, T. L., Girling, M., May, C. R., Mair, F. S., Murray, E., Treweek, S., McColl, E., Steen, I. N., Cook, C., Vernazza, C., Mackintosh, N., Sharma, S., Barbery, G., Steele, J., and Rapley, T.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: BMC Medical Research Methodology
• Publisher: BioMed Central
• ISSN: 1471-2288
• ISSN (Online): 1471-2288
• Published Online: 15 November 2018
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in BMC Medical Research Methodology 18:135
• Publisher Policy: Reproduced under a Creative Commons License