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

Abstract

BackgroundThe original British instrument the Normalization Process Theory Measure (NoMAD) is based on the four core constructs of the Normalization Process Theory: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring. They represent ways of thinking about implementation and are focused on how interventions can become part of everyday practice.AimTo translate and adapt the original NoMAD into the Swedish version S-NoMAD and to evaluate its psychometric properties based on a pilot test in a health care context including in-hospital, primary, and community care contexts.MethodsA systematic approach with a four-step process was utilized, including forward and backward translation and expert reviews for the test and improvement of content validity of the S-NoMAD in different stages of development. The final S-NoMAD version was then used for process evaluation in a pilot study aimed at the implementation of a new working method for individualized care planning. The pilot was executed in two hospitals, four health care centres, and two municipalities in a region in northern Sweden. The S-NoMAD pilot results were analysed for validity using confirmatory factor analysis, i.e. a one-factor model fitted for each of the four constructs of the S-NoMAD. Cronbach’s alpha was used to ascertain the internal consistency reliability.ResultsIn the pilot, S-NoMAD data were collected from 144 individuals who were different health care professionals or managers. The initial factor analysis model showed good fit for two of the constructs (Coherence and Cognitive Participation) and unsatisfactory fit for the remaining two (Collective Action and Reflexive Monitoring) based on three items. Deleting those items from the model yielded a good fit and good internal consistency (alphas between 0.78 and 0.83). However, the estimation of correlations between the factors showed that the factor Reflexive Monitoring was highly correlated (around 0.9) with the factors Coherence and Collective Action.ConclusionsThe results show initial satisfactory psychometric properties for the translation and first validation of the S-NoMAD. However, development of a highly valid and reliable instrument is an iterative process, requiring more extensive validation in various settings and populations. Thus, in order to establish the validity and reliability of the S-NoMAD, additional psychometric testing is needed.

Implementation outcome instruments for use in physical healthcare settings: a systematic review

“…Of the 372 manuscripts screened, 58 were eligible for inclusion and data were extracted. Fifty-eight manuscripts [76][77][78][79]. No studies of intruments measuring implementation cost were identified (see Fig.…”

“…Acceptability: consumer = 10 [23,37,39,41,42,44,51,52,57,59], provider = 27 [24-36, 38, 40, 43, 45-50, 53-56, 58] Appropriateness: consumer = 3 [61][62][63], provider = 3 [46,60,64], both consumer and provider = 1 [65] Adoption: consumer = 1 [66], provider = 3 [67][68][69] Feasibility: provider = 4 [46,70,71,80] Penetration: organisation = 4 [72][73][74][75] Sustainability: provider = 2 [76,77], organisation = 2 [78,79] Methodological quality Table 1 presents the global COSMIN scores for reliability, validity and responsiveness, and rank orders the instruments by descending reliability scores. Detailed COSMIN scores for individual measurement properties are presented in Additional file 3.…”

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“…The measurement instruments used to assess implementation success or related outcomes (i.e. NoMAD, ORIC, and implementation costs measure) are relatively new, though promising [ 42 – 44 , 51 ]. Experience of the field to use these validated measures is low, and therefore, the interpretation might not be as straightforward compared to well-established instruments.…”

“…The NoMAD is a self-report instrument measuring the degree of normalization by focusing on four constructs as defined by the Normalization Process Theory [ 35 ]: coherence, cognitive participation, collective action, and reflexive monitoring. The NoMAD shows high internal consistency and has been validated in heterogeneous samples across languages and settings [ 42 – 44 ].…”

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“…The NPT has been widely used to analyse the implementation of complex health care interventions and has proven to be useful and beneficial [17]. Although it is a new approach to assess an implementation process using NoMAD, the instrument has been tested in a Swedish version [32].…”