Background:
Although empirical and theoretical understanding of processes of implementation in healthcare is advancing, translation of theory into structured measures that capture the complexinterplay between interventions, individuals and context remain limited. This paper aimed to(1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify keyissues and methodological challenges for advancing work in this field.
Methods:
A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuringnormalisation processes in the context of e-health service interventions was developed on thebasis on Normalization Process Theory (NPT). NPT focuses on how new practices becomeroutinely embedded within social contexts. The instrument was pre-tested in two health caresettings in which e-health (electronic facilitation of healthcare decision-making and practice)was used by health care professionals.
Results:
The developed instrument was pre-tested in two professional samples (N = 46; N = 231).Ratings of items representing normalisation ‘processes’ were significantly related to staffmembers’ perceptions of whether or not e-health had become ‘routine’. Key methodologicalchallenges are discussed in relation to: translating multi-component theoretical constructs intosimple questions; developing and choosing appropriate outcome measures; conductingmultiple-stakeholder assessments; instrument and question framing; and more general issuesfor instrument development in practice contexts.
Conclusions:
To develop theory-derived measures of implementation process for progressing research inthis field, four key recommendations are made relating to (1) greater attention to underlyingtheoretical assumptions and extent of translation work required; (2) the need for appropriatebut flexible approaches to outcomes measurement; (3) representation of multiple perspectivesand collaborative nature of work; and (4) emphasis on generic measurement approaches thatcan be flexibly tailored to particular contexts of study.