Improving the normalization of complex interventions: part 2 - validation of the NoMAD instrument for assessing...

Area of Science:

• Health Services Research
• Implementation Science
• Psychometrics

Background:

• Successful integration of new healthcare practices depends on collective action within healthcare settings.
• Normalization Process Theory (NPT) explains practice embedding through collective action.
• The need for a practical tool to assess NPT constructs for implementation success was identified.

Purpose of the Study:

• To develop and validate an instrument (NoMAD) to measure staff perceptions of factors relevant to the embedding of healthcare interventions.
• To extend the practical utility of Normalization Process Theory (NPT) for improving implementation success.

Main Methods:

• An iterative instrument development process including item generation, consensus, appraisal, and cognitive testing.
• A 46-item questionnaire was pilot-tested on 831 staff across 6 sites implementing health interventions.
• Confirmatory factor analysis (CFA) was used to test the theoretical structure and psychometric properties of the reduced 23-item instrument.

Main Results:

• The NoMAD instrument demonstrated acceptable model fit in CFA (CFI=0.95, TLI=0.93, RMSEA=0.08, SRMR=0.03).
• Construct validity for the four NPT constructs was supported, with good internal consistency (Cronbach's alpha ranging from 0.65 to 0.81).
• The overall NoMAD scale showed high reliability (20 items, α=0.89).

Conclusions:

• The NoMAD instrument possesses good face validity, construct validity, and internal consistency for assessing staff perceptions of intervention embedding.
• The validated NoMAD tool can be utilized for evaluating and guiding the implementation of healthcare interventions.
• The findings support the use of NoMAD in research and practice to enhance the successful embedding of new work practices.