Abstract
BackgroundAlthough empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field.MethodsA 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals.ResultsThe developed instrument was pre-tested in two professional samples (N = 46; N = 231). Ratings of items representing normalisation ‘processes’ were significantly related to staff members’ perceptions of whether or not e-health had become ‘routine’. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.ConclusionsTo develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study.
Highlights
Empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited
This paper aims to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring processes involved in the implementation of e-health interventions; and (2) identify key issues and methodological challenges for further advancing work in this field
These analyses indicated that, for a number of items, stronger positive endorsement was indicated by participants who perceived e-health to be routine, supporting the Normalization Process Theory (NPT)
Summary
Empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. Obstacles to the use of theory for such purposes are numerous, and include the identification of relevant and useful theoretical perspectives from the huge body of literature on implementation that spans diverse academic disciplines (for example, psychology, sociology, business, healthcare management) Such theoretical diversity includes approaches that emphasise attitudes and behaviours [8,12,13]; diffusion and adoption of innovations through social networks [14]; and Science and Technology Studies (STS) approaches [15,16] that emphasise technology design and its relations with human actors.
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