The NASSS framework for ex post theorisation of technology-supported change in healthcare: Worked example of the TORPEDO programme
<p><strong>Background:</strong><br /> Evaluation of health technology programmes should be theoretically informed, interdisciplinary, and generate in-depth explanations. The NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework was developed to study u...
| Auteurs principaux: | , , , , , , |
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| Format: | Journal article |
| Langue: | English |
| Publié: |
BioMed Central
2019
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| _version_ | 1826298514147115008 |
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| author | Abimbola, S Patel, B Peiris, D Patel, A Harris, M Usherwood, T Greenhalgh, T |
| author_facet | Abimbola, S Patel, B Peiris, D Patel, A Harris, M Usherwood, T Greenhalgh, T |
| author_sort | Abimbola, S |
| collection | OXFORD |
| description | <p><strong>Background:</strong><br />
Evaluation of health technology programmes should be theoretically informed, interdisciplinary, and generate in-depth explanations. The NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework was developed to study unfolding technology programmes in real time—and in particular to identify and manage their emergent uncertainties and interdependencies. In this paper, we offer a worked example of how NASSS can also inform ex post (i.e. retrospective) evaluation.</p><br />
<p><strong>Methods:</strong><br />
We studied the TORPEDO (Treatment of Cardiovascular Risk in Primary Care using Electronic Decision Support) research programme, a multi-faceted computerised quality improvement intervention for cardiovascular disease prevention in Australian general practice. The technology (HealthTracker) had shown promise in a cluster randomised controlled trial (RCT), but its uptake and sustainability in a real-world implementation phase was patchy. To explain this variation, we used NASSS to undertake secondary analysis of the multi-modal TORPEDO dataset (results and process evaluation of the RCT, survey responses, in-depth professional interviews, videotaped consultations) as well as a sample of new, in-depth narrative interviews with TORPEDO researchers.</p><br />
<p><strong>Results:</strong><br />
Ex post analysis revealed multiple areas of complexity whose influence and interdependencies helped explain the wide variation in uptake and sustained use of the HealthTracker technology: the nature of cardiovascular risk in different populations, the material properties and functionality of the technology, how value (financial and non-financial) was distributed across stakeholders in the system, clinicians’ experiences and concerns, organisational preconditions and challenges, extra-organisational influences (e.g. policy incentives), and how interactions between all these influences unfolded over time.</p><br />
<p><strong>Conclusion:</strong><br />
The NASSS framework can be applied retrospectively to generate a rich, contextualised narrative of technology-supported change efforts and the numerous interacting influences that help explain its successes, failures, and unexpected events. A NASSS-informed ex post analysis can supplement earlier, contemporaneous evaluations to uncover factors that were not apparent or predictable at the time but dynamic and emergent.</p> |
| first_indexed | 2024-03-07T04:48:01Z |
| format | Journal article |
| id | oxford-uuid:d3f90a75-dd21-4eae-b086-3a672b8f363e |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T04:48:01Z |
| publishDate | 2019 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:d3f90a75-dd21-4eae-b086-3a672b8f363e2022-03-27T08:15:07ZThe NASSS framework for ex post theorisation of technology-supported change in healthcare: Worked example of the TORPEDO programmeJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:d3f90a75-dd21-4eae-b086-3a672b8f363eEnglishSymplectic ElementsBioMed Central2019Abimbola, SPatel, BPeiris, DPatel, AHarris, MUsherwood, TGreenhalgh, T<p><strong>Background:</strong><br /> Evaluation of health technology programmes should be theoretically informed, interdisciplinary, and generate in-depth explanations. The NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework was developed to study unfolding technology programmes in real time—and in particular to identify and manage their emergent uncertainties and interdependencies. In this paper, we offer a worked example of how NASSS can also inform ex post (i.e. retrospective) evaluation.</p><br /> <p><strong>Methods:</strong><br /> We studied the TORPEDO (Treatment of Cardiovascular Risk in Primary Care using Electronic Decision Support) research programme, a multi-faceted computerised quality improvement intervention for cardiovascular disease prevention in Australian general practice. The technology (HealthTracker) had shown promise in a cluster randomised controlled trial (RCT), but its uptake and sustainability in a real-world implementation phase was patchy. To explain this variation, we used NASSS to undertake secondary analysis of the multi-modal TORPEDO dataset (results and process evaluation of the RCT, survey responses, in-depth professional interviews, videotaped consultations) as well as a sample of new, in-depth narrative interviews with TORPEDO researchers.</p><br /> <p><strong>Results:</strong><br /> Ex post analysis revealed multiple areas of complexity whose influence and interdependencies helped explain the wide variation in uptake and sustained use of the HealthTracker technology: the nature of cardiovascular risk in different populations, the material properties and functionality of the technology, how value (financial and non-financial) was distributed across stakeholders in the system, clinicians’ experiences and concerns, organisational preconditions and challenges, extra-organisational influences (e.g. policy incentives), and how interactions between all these influences unfolded over time.</p><br /> <p><strong>Conclusion:</strong><br /> The NASSS framework can be applied retrospectively to generate a rich, contextualised narrative of technology-supported change efforts and the numerous interacting influences that help explain its successes, failures, and unexpected events. A NASSS-informed ex post analysis can supplement earlier, contemporaneous evaluations to uncover factors that were not apparent or predictable at the time but dynamic and emergent.</p> |
| spellingShingle | Abimbola, S Patel, B Peiris, D Patel, A Harris, M Usherwood, T Greenhalgh, T The NASSS framework for ex post theorisation of technology-supported change in healthcare: Worked example of the TORPEDO programme |
| title | The NASSS framework for ex post theorisation of technology-supported change in healthcare: Worked example of the TORPEDO programme |
| title_full | The NASSS framework for ex post theorisation of technology-supported change in healthcare: Worked example of the TORPEDO programme |
| title_fullStr | The NASSS framework for ex post theorisation of technology-supported change in healthcare: Worked example of the TORPEDO programme |
| title_full_unstemmed | The NASSS framework for ex post theorisation of technology-supported change in healthcare: Worked example of the TORPEDO programme |
| title_short | The NASSS framework for ex post theorisation of technology-supported change in healthcare: Worked example of the TORPEDO programme |
| title_sort | nasss framework for ex post theorisation of technology supported change in healthcare worked example of the torpedo programme |
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