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Cited by 102Health Policy Implementation ScienceEvaluation and Performance AssessmentElectronic Health Records Systems

The DOI matches its Crossref record; 49 of the 51 references it cites were found in a registry or an index.

The NASSS framework for ex post theorisation of technology-supported change in healthcare: worked example of the TORPEDO programme

Open access
Abimbola, Seye, Patel, Bindu, Peiris, David, Patel, Anushka, Harris, Mark, Usherwood, Tim, Greenhalgh, Trisha·2019·BMC Medicine
DOI 10.1186/s12916-019-1463-xPMC PMC6937726
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Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

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Fig. 1 The NASSS framework for studying non-adoption and abandonment of technologies by individuals and the challenges to scale-up, spread, and sustainability of such technologies in health and care organisations (adapted from Greenhalgh et al. [10])
Fig. 1 The NASSS framework for studying non-adoption and abandonment of technologies by individuals and the challenges to scale-up, spread, and sustainability of such technologies in health and care organisations (adapted from Greenhalgh et al. [10])CC BY · PubMed Central
Fig. 2 Screenshot of the HealthTracker technology
Fig. 2 Screenshot of the HealthTracker technologyCC BY · PubMed Central

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Research works printed but not linked: 2

  1. Patel B, Usherwood T, Harris M, Patel A, Panaretto K, SZwar N, Peiris D: What drives adoption of computerised quality improvement tools by primary healthcare providers? An application of Normalisation Process Theory. Submitted to Implementation Science [?] 2018.
  2. England NHS. Five-year forward view. London: NHS England; 2014.

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Metadata

Authors
Abimbola, S., Patel, B., Peiris, D., Patel, A., Harris, M., Usherwood, T., & Greenhalgh, T.
Affiliations
  • UNSW Sydney (AU)
  • The University of Sydney (AU)
Corresponding author
Greenhalgh, Trisha
ORCID
Venue
BMC Medicine
Publisher
Springer Science and Business Media LLC
Published
2019-12
Volume
17
Issue
1
Pages
233-233
ISSN
1741-7015 (ISSN-L)
DOI
10.1186/s12916-019-1463-x
PMC
PMC6937726
OpenAlex
W2997344043
Cited by
102
References
51
Citations by year
2026: 15 · 2025: 16 · 2024: 24 · 2023: 19 · 2022: 18 · 2021: 6 · 2020: 4
FWCI
9.53
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
National Institute for Health Research (BRC-1215-2008)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Public Administration › Evaluation and Performance Assessment
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Keywords
NASSS framework, ex-post evaluation, implementation evaluation, cardiovascular risk management, electronic decision support, general practice, clinician experience, policy incentives, process evaluation
MeSH terms
Cardiovascular Diseases, Humans, Retrospective Studies, Technology Assessment, Biomedical, Randomized Controlled Trials as Topic, Disease Management, Decision Support Systems, Clinical, Biomedical Technology, Quality Improvement

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