Department of Nursing, Midwifery and Health, Northumbria University, Coach Lane, Newcastle-upon-Tyne, NE7 7XA, UK.
Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX, UK.
BMC Med Res Methodol. 2018 Nov 15;18(1):135. doi: 10.1186/s12874-018-0591-x.
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.
简介：新医疗保健实践的成功实施和嵌入依赖于在医疗保健环境的限制内工作的个人的协调、集体行为。常规化过程理论（NPT）提供了一种实施理论，强调通过集体行动来解释和塑造新实践的嵌入。为了扩展 NPT 用于提高实施成功率的实际效用，开发并验证了一种工具（NoMAD）。
方法：通过一个迭代过程，对作者开发的工具进行描述性分析和心理测量测试，该过程包括项目生成、共识方法、项目评估和认知测试。一个包含 46 个项目的问卷在 6 个实施健康相关干预的地点进行了测试，使用纸质和在线完成。参与者是直接参与干预工作的员工。使用描述性分析和共识方法来消除冗余，将最终工具减少到 23 个项目。数据进行了验证性因子分析，旨在在样本中确认理论结构。
结果：我们获得了 831 份完整的问卷，平均回复率为 39%（范围：22-77%）。完整完成项目的比例为 50%（n=413）。验证性因子分析表明，该模型的拟合度可接受（CFI=0.95，TLI=0.93，RMSEA=0.08，SRMR=0.03）。NPT 的四个理论结构的构建效度得到支持，内部一致性（Cronbach's alpha）如下：一致性（4 个项目，α=0.71）；集体行动（7 个项目，α=0.78）；认知参与（4 个项目，α=0.81）；反思性监测（5 个项目，α=0.65）。整体规范化量表非常可靠（20 个项目，α=0.89）。
结论：NoMAD 工具具有良好的表面效度、结构效度和内部一致性，可用于评估员工对改变其工作实践的干预措施相关因素的看法。提出了用于评估和指导实施的用途。
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