Improving the normalization of complex interventions: Part 2 - Validation of the NoMAD instrument for assessing implementation work based on Normalization Process Theory (NPT)

Tracy Finch*, Melissa Girling, Carl R. May, Frances S. Mair, Elizabeth Murray, Shaun Treweek, Elaine McColl, Ian Steen, Clare Cook, Christopher Vernazza, Nicola Mackintosh, Samridh Sharma, Gaery Barbery, Jimmy Steele, Timothy Rapley

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

37 Citations (Scopus)
3 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
Early online date15 Nov 2018
DOIs
Publication statusPublished - Dec 2018

Cite this