Utility of the NoMAD tool in assessing implementation issues – Experience from the dallas (Delivering Assisted Living Lifestyles At Scale) programme

Problem

Success in any digital health innovation requires a detailed understanding of the processes underpinning its implementation. NoMAD (normalisation of complex interventions-measure development) is a survey tool designed to explore the perspectives of health professionals/key implementers of the barriers and facilitators of the implementation of a new initiative. NoMAD questions were derived from Normalisation Process Theory (NPT). The aim was to evaluate the usefulness of NoMAD in exploring the readiness of health professionals to implement two dallas services, the eRedbook- a digital online version to replace the conventional book and ‘No Delays’- an electronic tool designed to support patient self-management by the prescription of a ‘digital postcard’.

Approach

The NoMAD team worked with the dallas consortia to adapt the survey questions to each initiative and identify appropriate staff for inclusion in the respective surveys. Staff were surveyed at one point in time (May 2014 eRedbook; May 2015 No Delays). Anonymised data was grouped according to professional role and the data analysed descriptively.

Findings

There was a 29% response rate for eRedbook (67/232) and 21% for No delays (86/400)eRedbook –Participants were described as ‘champions’ if their role involved driving the initiative forward, or promoters if involved in the implementation process. The initiative felt new to most (93%) promoters at the time of the survey but promisingly, most felt it would become a normal part of their work. Survey responses demonstrated a good level of engagement although some differences were noted between the champions and promoters regarding the perception of being able to make an important contribution (86% v 53%). Key barriers to implementation included insufficient training, resources and limited access to reports about the effects of eRedbook. No Delays- the initiative felt new to 57% participants but 69% agreed that it had potential for becoming a normal part of their work. Responses were very positive for engagement with 80% believing that participating in the initiative was an important part of their role. However, again insufficient training and resources was an issue and only 10% had access to reports about the effects of No Delays.

Consequences

The NoMAD tool provided useful insights into health professionals’ perceptions during the implementation process for each initiative and the findings from it resonated with the large volume of qualitative data collected in parallel as part of the wider dallas evaluation. Responses for both initiatives were generally positive about engagement; but there was scope for improving understanding about the potential benefits of each initiative. The need for adequate provision of training and resources was highlighted. The NoMAD tool helped demonstrate that by listening to the implementers, key learning points can be revealed which can help allow the smooth integration of the initiative.