From theory to 'measurement' in complex interventions: Methodological lessons from the development of an e-health normalisation instrument
by Frances Mair
Co-authored with: Tracy L Finch, Catherine O'Donnell, Elizabeth Murray and Carl R May
Abstract (provisional)
Background
Although empirical and theoretical understanding of processes of... more
Abstract (provisional)
Background
Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay 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 key issues and methodological challenges for advancing work in this field.
Methods
A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings 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 staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.
Conclusions
To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study.
Can computerized clinical decision support systems improve practitioners' diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review.
Co-authored with John J You, Jasmine Dhaliwal, David Koff, Jean A Mackay, Lorraine Weise-Kelly, Tamara Navarro, Nancy L Wilczynski, R BRIAN Haynes, CCDSS Systematic Review Team .
Computerized clinical decision support systems for chronic disease management: A decision-maker-researcher partnership systematic review
Co-authored with Shikha Misra, Hertzel C Gerstein, Amit X Garg, Rolf J Sebaldt, Jean A Mackay, Lorraine Weise-Kelly, Tamara Navarro, Nancy L Wilczynski, R Brian Haynes and CCDSS Systematic Review Team .
The introduction of electronic medication charts and prescribing in aged care facilities: An evaluation. Burns P, Perkins DA, Larsen K and Dalley A. (2007). Australasian Journal on Ageing. 26 (3) pp131.
by Pippa Burns
The objective was to test the feasibility of electronic medication charts in aged care facilities and the impact on... more
The objective was to test the feasibility of electronic medication charts in aged care facilities and the impact on general practitioner (GP) and staff work processes. The Illawarra Division of General Practice conducted a trial where GPs used a modified version of commercially available software to generate medication charts, in four residential aged care facilities. Semistructured, face-to-face interviews, log books and an issue register were used to evaluate the success of this trial.
The system improved chart clarity, which was felt to have improved medication management accuracy. However, system usability was hindered by the location of the computer, the availability of prescription paper, and technical difficulties. The system is inexpensive and three facilities have continued to use it after the trial period.
To show measurable improvements in medication management, a trial that includes all residents is needed.
Aged care facilities need more computer equipment in order to adopt important innovations.
Patient Path and Workflow Optimization Using an RFID-PACS Integrated System
by Mario Ciampi
M. Magliulo, M. Ciampi, and M. Esposito, International Journal of Computer Assisted Radiology and Surgery, vol. 3, supp. 1, pp. 327-328, 2008, Springer Berlin/Heidelberg
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