The Swedish version of the Normalization Process Theory Measure S-NoMAD: translation, adaptation, and pilot testing

Area of Science:

• Healthcare implementation science
• Psychometric validation
• Health services research

Background:

• The Normalization Process Theory Measure (NoMAD) assesses intervention implementation through four constructs: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring.
• These constructs guide understanding of how interventions integrate into routine healthcare practices.

Purpose of the Study:

• To translate the British NoMAD into Swedish (S-NoMAD).
• To evaluate the psychometric properties of the S-NoMAD through a pilot study in diverse Swedish healthcare contexts (in-hospital, primary, community care).

Main Methods:

• A systematic four-step translation process including forward/backward translation and expert reviews.
• Pilot study involving 144 healthcare professionals/managers across various care settings.
• Confirmatory factor analysis and Cronbach's alpha were used to assess validity and reliability.

Main Results:

• The S-NoMAD demonstrated good fit for Coherence and Cognitive Participation constructs.
• After item deletion, the model showed good fit and internal consistency (Cronbach's alpha 0.78–0.83) for all constructs.
• High correlations were observed between Reflexive Monitoring and other factors, suggesting potential areas for refinement.

Conclusions:

• The S-NoMAD exhibits satisfactory initial psychometric properties for its first validation.
• Further extensive validation in varied settings and populations is necessary to fully establish the S-NoMAD's validity and reliability.
• The iterative nature of instrument development requires ongoing psychometric testing for robust clinical application.