Introduction
Methods
Theoretical underpinning
Construct | Definition |
---|---|
Coherence | Sense-making that promotes or inhibits the coherence of a practice to its users. These processes are energized by investments of meaning made by participants |
Cognitive participation | Participation that promotes or inhibits users’ enrolment and legitimisation of a practice. These processes are energized by investments of commitment made by participants. |
Collective Action | Activity that promotes or inhibits the enacting of a practice by its users. These processes are energized by investments of effort made by participants. |
Reflexive monitoring | Practices that promote or inhibit users’ comprehension of the effects of a practice. These processes are energized by investments in appraisal made my participants. |
Item generation and instrument development
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When you use [intervention], how familiar does it feel?
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Do you feel that [intervention] is currently a normal part of your work?
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Do you feel that [intervention] will become a normal part of your work?
NoMAD validation study
Study participants
Data collection
Instrument refinement
Sub-construct | Item | Strength of correlation with global items (high/mod/low) | Correlation with other s-c items? | Higher correlation with items in other s-c? | Noteworthy correlation with other construct items? | Level of option B responding? % |
---|---|---|---|---|---|---|
Differentiation1 | I can distinguish the [intervention] from usual ways of working | Best for ‘will become’ (0.35), v low for other items. | Correlation of .70 with each other. | No | No | 8.9 |
Differentiation2 | I can see how the [intervention] differs from usual ways of working | Similar to diff1 (0.29 highest). | No | No | 8.1 | |
Communal spec1 | Staff in this organisation have a shared understanding of the purpose of the [intervention] | Approx 0.30 across all 3. | Moderate (0.59) | No | IndivSpec1 (0.50) | 4.2 |
Communal spec2 | Staff in this organisation have shared expectations about the likelihood of the success of the [intervention] | Low. Highest is 0.26 for ‘will become’. | No | Activation2 (0.51). Correlations with appraisal items in RefMon (0.46–.50). | 5.0 | |
Individual spec1 | I understand what tasks the [intervention] requires of me | Mod (0.40–0.47) | Moderate (0.67) | No | Internalization items (0.60 approx). CommSpec1 (0.50). Workability items (0.48&0.50). Legitimation items in CP (0.45 & 0.46) | 3.3 |
Individual spec2 | I understand how the [intervention] affects the nature of my own work | Mod (0.38–0.41) | No | Similar as for IndSpec1. | 3.1 | |
Internalization1 | I can see the potential value of the [intervention] for my work | Varies across 3 items. Mod (0.48) for ‘will become’, 0.34 for ‘is normal’, 0.29 for familiarity. | High (0.83) | No | IndSpec2, 0.61. Legit1, 0.61. Activ1, 0.65. Mod with appraisal items (RefMon), approx. 0.50–0.58 (IndApprais3). | 2.3 |
Internalization2 | I can see the worth of the [intervention] for me | Similar for items 1&2 (0.31 & 0.35). Mod (0.49) for ‘will become’. | As for internalisation1 | 2.5 |
Construct | Sub-Construct | Items |
---|---|---|
Coherence
|
Differentiation
| I can see how the [intervention] differs from usual ways of working |
Communal specification
| Staff in this organisation have a shared understanding of the purpose of this [intervention] | |
Individual specification
| I understand how the [intervention] affects the nature of my own work | |
Internalization
| I can see the potential value of the [intervention] for my work | |
Cognitive Participation
|
Initiation
| There are key people who drive the [intervention] forward and get others involved |
Legitimation
| I believe that participating in the [intervention] is a legitimate part of my role | |
Enrolment
| I’m open to working with colleagues in new ways to use the [intervention] | |
Activation
| I will continue to support the [intervention] | |
Collective Action
|
Interactional workability
| I can easily integrate the [intervention] into my existing work |
Relational integration
| The [intervention] disrupts working relationships | |
Relational integration
| I have confidence in other people’s ability to use the [intervention] | |
Skill set workability
| Work is assigned to those with skills appropriate to the [intervention] | |
Skill set workability
| Sufficient training is provided to enable staff to use the [intervention] | |
Contextual Integration
| Sufficient resources are available to support the [intervention] | |
Contextual integration
| Management adequately support the [intervention] | |
Reflexive Monitoring
|
Systemisation
| I am aware of reports about the effects of the [intervention] |
Communal appraisal
| The staff agree that the [intervention] is worthwhile | |
Individual appraisal
| I value the effects the [intervention] has had on my work | |
Reconfiguration
| Feedback about the [intervention] can be used to improve it in the future | |
Reconfiguration
| I can modify how I work with the [intervention] |
Psychometric analysis
Ethics
Results
Response
Dataset | Mode of administration | Invited | Responded | RR Total N/ Invited | Number of items completed | Total completing 1–43 items | |
---|---|---|---|---|---|---|---|
1–42 items | All 43 items | ||||||
S1: Digital Health | Electronic + paper | 231 | 67 | 29% | 16 | 37 | 53 |
S2: Smoking cessation | Paper | 100 | 21 | 21% | 3 | 18 | 21 |
S3: Patient self-management | Electronic | 400 | 91 | 23% | 26 | 51 | 77 |
S4: Oral Health Risk Assessement | Paper with personal approach Electronic (5th years) | 297 | 229 | 77% | 26 | 194 | 220 |
S5: System level IT | Electronic | 395 | 87 | 22% | 14 | 53 | 67 |
S6: Sports programme | Electronic – not targeted | Unknown | 336 | Unknown | 24 | 60 | 84 |
Total/ Overall | >1423a | 831 | 35%a | 109 | 413 | 522 |
Participant characteristics
Site 1: Digital health record (N = 53) | Site 2: Smoking cessation (N = 21) | Site 3: Patient self-management tool (N = 77) | Site 5: Technology implementation (N = 67) | Site 6 (N = 84) | |||||
---|---|---|---|---|---|---|---|---|---|
Professional Role | Professional Role | Professional Role | Professional Role | Organisation level | |||||
Health visitor | 76 (40) | Community Midwife | 67 (14) | GP | 35 (27) | Consultant | 24 (16) | National Sporting organisation | 6 (5) |
Nursery nurse | 6 (3) | Hospital midwife | 24 (5) | Hospital Doctor | 5 (4) | Trainee Doctor | 5 (3) | State Sports Organisation (SSO) | 14 (12) |
Team leader | 2 (1) | Stop smoking advisor | 5 (1) | Consultant | 4 (3) | Nurse Band 5 | 19 (13) | League | 11 (9) |
Student health visitor | 9 (5) | Stop smoking clerical/admin | 0 (0) | Occupational Therapist | 1 (1) | Nurse Band 6 | 22 (15) | Club | 61 (51) |
Family nurse partnership | 8 (4) | (missing) | 5 (1) | Physiotherapist | 21 (16) | Nurse Band 7 | 15 (10) | Other | 8 (7) |
(missing) | 0 (0) | Practice Nurse | 17 (13) | Nurse Band 8 | 2 (1) | ||||
Hospital Nurse | 9 (7) | Admin clerical - secretary | 2 (1) | Role in Organisation | |||||
School Nurse | 1 (1) | Manager | 5 (3) | Administrator (Paid) | 20 (17) | ||||
Dietician | 4 (3) | Physiotherapist | 2 (1) | Administrator (Volunteer) | 39 (33) | ||||
Pharmacist | 3 (2) | Dietician | 3 (2) | Coach | 31 (26) | ||||
missing | 0 (0) | Pharmacist | 2 (1) | Other | 10 (8) | ||||
Other | 2 (1) | ||||||||
Main role in relation to the intervention | Main role in relation to the intervention | Geographic region (role not elicited) | Main role in relation to the intervention | Main role in relation to the intervention | |||||
Champion | 13 (7) | I am involved in managing or overseeing [name] intervention | 19 (4) | Region 1 | 55 (42) | I am involved in managing, overseeing or being a clinician | 28 (19) | I’m involved in implementing [sports programme] | 57 (48) |
Promoter | 87 (46) | I am involved in delivering the [name] intervention | 62 (13) | Region 2 | 34 (26) | I will be involved in working with the system of [name] | 69 (46) | I’m involved in managing/overseeing [programme] | 43 (36) |
missing | 19 (4) | Region 3 | 12 (9) | Missing | 3 (2) | ||||
Years worked in the Trust | Years worked in the Trust | Years worked in the Trust | Years worked in the Trust | ||||||
< 1 year | 15 (8) | < 1 year | 10 (2) | < 1 year | 0 (0) | < 1 year | 10 (7) | ||
1–2 years | 15 (8) | 1–2 years | 0 | 1–2 years | 1 (1) | 1–2 years | 15 (10) | ||
3–5 years | 9 (5) | 3–5 years | 5 (1) | 3–5 years | 7 (5) | 3–5 years | 19 (13) | ||
6–10 years | 21 (11) | 6–10 years | 5 (1) | 6–10 years | 10 (8) | 6–10 years | 30 (20) | ||
11–15 years | 21 (11) | 11–15 years | 24 (5) | 11–15 years | 14 (11) | 11–15 years | 15 (10) | ||
> 15 years | 19 (10) | > 15 years | 52 (11) | > 15 years | 68 (52) | > 15 years | 10 (7) | ||
missing | 0 | missing | 5 (1) | missing | 0 |
Site 4: Oral health risk assessment Student dentists (N = 189) | Site 4: Oral health risk assessment Clinicians (N = 31) | ||
---|---|---|---|
Year of study | Professional Role | ||
3rd Year | 40 (77) | Clinical Fellow | 13 (4) |
4th Year | 41 (77) | Senior lecturer | 7 (2) |
5th Year | 20 (37) | Professor | 10 (3) |
Associate Clinical Lecturer | 55 (17) | ||
Clinical Trainer | 7 (2) | ||
StR/SpR | 7 (2) | ||
Missing | 3 (1) | ||
Main role in relation to the intervention | Main role in relation to the intervention | ||
I oversee others delivering [risk assessment] scores | Yes: 84 (26) No: 3 (1) DA: 13 (4) | ||
I directly deliver the [risk assessment] scores to patients | Yes: 94 (177) No: 6 (12) | I directly deliver [risk assessment] scores to patients | Yes: 42 (13) No: 42 (13) DA: 16 (5) |
I use and deliver [risk assessment] scores in another setting | Yes: 6 (12 No: 74 (139) DA: 20 (38) | I use and deliver [risk assessment] scores in another setting | Yes: 23 (7) No: 58 (18) DA: 19 (6) |
Years worked in the [Dental Hospital] | |||
< 1 year | 10 (3) | ||
1–2 years | 10 (3) | ||
3–5 years | 19 (6) | ||
6–10 years | 16 (5) | ||
11–15 years | 13 (4) | ||
> 15 years | 32 (10) |
Relationships amongst NPT constructs
Coherence | Cognitive Participation | Collective Action | |
---|---|---|---|
Coherence | 1 | ||
Cognitive Participation | .68 (n = 512) | 1 | |
Collective Action | .55 (n = 454) | .54 (n = 456) | 1 |
Reflexive Monitoring | .60 (n = 427) | .59 (n = 428) | .49 (n = 423) |
How familiar? | Normal part of your work? | Will it become normal? | |
---|---|---|---|
Coherence | .35 (n = 448) | .43 (n = 447) | .54 (n = 443) |
Cognitive Participation | .25 (n = 431) | .30 (n = 430) | .47 (n = 426) |
Collective Action | .41 (n = 409) | .48 (n = 408) | .45 (n = 404) |
Reflexive Monitoring | .26 (n = 388) | .28 (n = 387) | .40 (n = 383) |
Normalisation score | .41 (n = 417) | .48 (n = 416) | .58 (n = 412) |
Factor structure
Parcel | Item | F1 | F2 | F3 | F4 |
---|---|---|---|---|---|
Coherence parcel 1 | I can see the potential value of the [intervention] for my work I can see how the [intervention] differs from usual ways of working | .74 | |||
Coherence parcel 2 | Staff in this organisation have a shared understanding of the purpose of this [intervention] I understand how the [intervention] affects the nature of my own work | .67 | |||
Cognitive participation parcel 1 | There are key people who drive the [intervention] forward and get others involved I will continue to support the [intervention] | .84 | |||
Cognitive participation parcel 2 | I believe that participating in the [intervention] is a legitimate part of my role I’m open to working with colleagues in new ways to use the [intervention] | .86 | |||
Collective action parcel 1 | The [intervention] disrupts working relationships I can easily integrate the [intervention] into my existing work | .67 | |||
Collective action parcel 2 | Work is assigned to those with skills appropriate to the [intervention] Sufficient resources are available to support the [intervention] | .57 | |||
Collective action parcel 3 | I have confidence in other people’s ability to use the [intervention] Sufficient training is provided to enable staff to use the [intervention] Management adequately support the [intervention] | .66 | |||
Reflexive monitoring parcel 1 | I am aware of reports about the effects of the [intervention] I value the effects the [intervention] has had on my work | .55 | |||
Reflexive monitoring parcel 2 | The staff agree that the [intervention] is worthwhile Feedback about the [intervention] can be used to improve it in the future I can modify how I work with the [intervention] | .70 |