Health Technology Adoption - The Usefulness of Normalisation Process Theory to inform Intervention Design

  • McCrorie, C. (Speaker)
  • Arabella Scantlebury (Speaker)
  • Owen Johnson (Speaker)
  • Ciarán McInerney (Speaker)
  • Jonathan Benn (Speaker)

Activity: Talk or presentation typesOral presentation


Background: Implementation science has produced methods and strategies to promote the successful uptake of complex interventions into routine healthcare practice. Applying these strategies to the implementation of health information technologies (HIT) has met with varying success due to issues such as workforce engagement and adoption. There is a lack of robust evidence on how to promote successful uptake of HIT within health care organisations (1). Normalisation Process Theory (NPT) offers a theory of implementation that focuses on the work that individuals and groups do to integrate new ways of working into routine practice (2). It has been suggested as a means to assessing the conditions in which interventions become normalised into practice, while others do not. We have previously reported on the expectations of health care professionals for a hospital-wide EHR system (3). Using this case study, we provide an example of the utility of NPT in highlighting challenges to the adoption of HIT.

Method: The case study took place in November 2016 at a single site and comprised of 14 semi-structured interviews with a range of hospital staff. Interview data was coded iteratively. The first stage involved analysing all data thematically (inductive coding), followed by mapping emergent themes onto the four core mechanisms of NPT: Coherence (understanding of reasons for implementation and potential value of the technology), Cognitive participation (preparedness to engage and commit to use the technology), Collective action (ability to do the work to use the technology) and Reflexive monitoring (how staff appraise the technology).

Results: We found that the four core mechanisms of NPT provided a useful lens for coding and interpretation of staff perspectives on the impending EHR implementation. There was universal acceptance for the potential value of the EHR, despite variation across staff groups in perceived intended purpose (Coherence). EHR was regarded as central to delivering patient care although the extent to which participants felt prepared for use varied across different staff groups and specific care contexts (Cognitive participation). Variation in the perceived compatibility of EHR with existing work practices was additionally reported (Collective action) and although EHR was expected to improve efficiency, there were concerns that the expected standardisation of the system could lead to non-use by some services (Reflexive monitoring). Interpreting the perceived barriers and facilitators to implementation from a patient safety perspective helped us to develop a theoretically-informed and evidence-based understanding of concerns that staff had for delivering safe patient care.

Implications: The findings indicate that for successful technology adoption it is important that users understand the reasons for the initiation, are prepared for and able to use the technology and appraise use as beneficial to care. NPT is often used retrospectively to understand implementation for interventions and technologies in a health service context. This study supports a role for the prospective application of NPT to guide implementation planning, as has been suggested in the context of other forms of digital health technology interventions.
PeriodJul 2020
Event titleHealth Service Research UK 13th Annual Conference 2020
Event typeConference
Conference number13
LocationOnline, United KingdomShow on map
Degree of RecognitionInternational