Freund Johanna, Piotrowski Alexandra, Bührmann Leah, Oehler Caroline, Titzler Ingrid, Netter Anna-Lena, Potthoff Sebastian, Ebert David Daniel, Finch Tracy, Köberlein-Neu Juliane, Etzelmüller Anne
Professorship Psychology & Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, Munich, 80992, Germany.
Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Implement Sci Commun. 2023 Oct 16;4(1):126. doi: 10.1186/s43058-023-00505-4.
Implementing evidence-based healthcare practices (EBPs) is a complex endeavour and often lags behind research-informed decision processes. Understanding and systematically improving implementation using implementation theory can help bridge the gap between research findings and practice. This study aims to translate, pilot, and validate a German version of the English NoMAD questionnaire (G-NoMAD), an instrument derived from the Normalisation Process Theory, to explore the implementation of EBPs.
Survey data has been collected in four German research projects and subsequently combined into a validation data set. Two versions of the G-NoMAD existed, independently translated from the original English version by two research groups. A measurement invariance analysis was conducted, comparing latent scale structures between groups of respondents to both versions. After determining the baseline model, the questionnaire was tested for different degrees of invariance (configural, metric, scalar, and uniqueness) across samples. A confirmatory factor analysis for three models (a four-factor, a unidimensional, and a hierarchical model) was used to examine the theoretical structure of the G-NoMAD. Finally, psychometric results were discussed in a consensus meeting, and the final instructions, items, and scale format were consented to.
A total of 539 health care professionals completed the questionnaire. The results of the measurement invariance analysis showed configural, partial metric, and partial scalar invariance indicating that the questionnaire versions are comparable. Internal consistency ranged from acceptable to good (0.79 ≤ α ≤ 0.85) per subscale. Both the four factor and the hierarchical model achieved a better fit than the unidimensional model, with indices from acceptable (SRMR = 0.08) to good (CFI = 0.97; TLI = 0.96). However, the RMSEA values were only close to acceptable (four-factor model: χ2164 = 1029.84, RMSEA = 0.10; hierarchical model: χ2166 = 1073.43, RMSEA = 0.10).
The G-NoMAD provides a reliable and promising tool to measure the degree of normalisation among individuals involved in implementation activities. Since the fit was similar in the four-factor and the hierarchical model, priority should be given to the practical relevance of the hierarchical model, including a total score and four subscale scores. The findings of this study support the further usage of the G-NoMAD in German implementation settings.
Both the AdAM project (No. NCT03430336, 06/02/2018) and the EU-project ImpleMentAll (No. NCT03652883, 29/08/2018) were registered on ClinicalTrials.gov. The ImplementIT study was registered at the German Clinical Trial Registration (No. DRKS00017078, 18/04/2019). The G-NoMAD validation study was registered at the Open Science Framework (No7u9ab, 17/04/2023).
实施循证医疗实践（EBPs）是一项复杂的工作，且往往落后于基于研究的决策过程。运用实施理论来理解并系统地改进实施过程，有助于弥合研究结果与实践之间的差距。本研究旨在翻译、试用并验证英文版《常态化过程理论问卷》（NoMAD）的德文版（G-NoMAD），该工具源自常态化过程理论，用于探索循证医疗实践的实施情况。
在四个德国研究项目中收集了调查数据，并随后合并为一个验证数据集。存在两个版本的G-NoMAD，由两个研究小组分别从原始英文版独立翻译而来。进行了测量不变性分析，比较了两个版本的受访者群体之间的潜在量表结构。确定基线模型后，对问卷在不同样本间的不变性程度（构型、度量、标量和唯一性）进行了测试。使用对三种模型（四因素模型、单维模型和层次模型）的验证性因素分析来检验G-NoMAD的理论结构。最后，在一次共识会议上讨论了心理测量结果，并就最终的指导说明、条目和量表格式达成了一致。
共有539名医疗保健专业人员完成了问卷。测量不变性分析结果显示构型、部分度量和部分标量不变性，表明问卷版本具有可比性。每个子量表的内部一致性从可接受到良好（0.79≤α≤0.85）。四因素模型和层次模型的拟合度均优于单维模型，指标从可接受（SRMR = 0.08）到良好（CFI = 0.97；TLI = 0.96）。然而，RMSEA值仅接近可接受水平（四因素模型：χ2164 = 1029.84，RMSEA = 0.10；层次模型：χ2166 = 1073.43，RMSEA = 0.10）。
G-NoMAD为测量参与实施活动的个体之间的常态化程度提供了一个可靠且有前景的工具。由于四因素模型和层次模型的拟合度相似，应优先考虑层次模型的实际相关性，包括总分和四个子量表得分。本研究结果支持在德国的实施环境中进一步使用G-NoMAD。
AdAM项目（编号NCT03430336，2018年2月6日）和欧盟项目ImpleMentAll（编号NCT03652883，2018年8月29日）均在ClinicalTrials.gov上注册。ImplementIT研究在德国临床试验注册中心注册（编号DRKS00017078，2019年4月18日）。G-NoMAD验证研究在开放科学框架注册（编号No7u9ab，2023年4月17日）。
