The implementation and validation of the NoMAD during a complex primary care intervention

Area of Science:

• Healthcare implementation science
• Health services research
• Clinical intervention assessment

Background:

• Normalization Process Theory (NPT) is a framework for understanding intervention implementation.
• The NoMAD (Normalization Measurement Development) questionnaire is a 23-item instrument based on NPT.
• This study describes the implementation experience and psychometric properties of the NoMAD.

Purpose of the Study:

• To describe the implementation experience of the NoMAD questionnaire.
• To evaluate the NoMAD as a feedback mechanism for complex health interventions.
• To further explore the psychometric properties of the NoMAD instrument.

Main Methods:

• The NoMAD was administered six times over 12 months to healthcare team members at seven sites implementing Health TAPESTRY.
• A visual traffic light summary (TLS) was used for feedback.
• Internal consistency and validity of the NoMAD were assessed.

Main Results:

• 56 healthcare team members completed the NoMAD across six sites.
• Implementation with multiple feedback points was time-consuming.
• Most internal consistency values (60%) and correlations (86%) among subscales were satisfactory and significant.
• Scores generally increased over 12 months, higher in experienced sites.

Conclusions:

• Fewer data collection points (e.g., three spaced over months) are recommended for repeated NoMAD administration for feedback.
• The study provides additional evidence for the psychometric properties of the NoMAD.
• The NoMAD can offer insights into the normalization of complex health interventions.