This study aimed to develop and validate an adaptable survey instrument derived from NPT, to be used to improve the implementation of complex healthcare interventions within organisational settings. Normalization Process Theory (NPT) provides a framework for understanding how a new intervention becomes part of normal practice. 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. Uses in evaluating and guiding implementation are proposed. 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. The normalisation scale overall, was highly reliable (20 items, α = 0.89). 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 confirmatory factor analysis showed the model achieved acceptable fit (CFI = 0.95, TLI = 0.93, RMSEA = 0.08, SRMR = 0.03).
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Full completion of items was 50% ( n = 413). We obtained 831 completed questionnaires, an average response rate of 39% (range: 22–77%). Data were subject to confirmatory factor analysis which sought to confirm the theoretical structure within the sample. Descriptive analysis and consensus methods were used to remove redundancy, reducing the final tool to 23 items. Participants were staff directly involved in working with the interventions. A 46 item questionnaire was tested in 6 sites implementing health related interventions, using paper and online completion. Methodsĭescriptive 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. To extend the practical utility of NPT for improving implementation success, an instrument (NoMAD) was developed and validated. Normalization Process Theory (NPT) provides a theory of implementation that emphasises collective action in explaining, and shaping, the embedding of new practices. 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.
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