The NASSS framework for ex post theorisation of technology-supported change in healthcare: worked example of the TORPEDO programme
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.
Abimbola S. P. B. Peiris D. Patel A. Harris M. Usherwood T. Greenhalgh T. 2019). The NASSS framework for ex post theorisation of technology-supported change in healthcare: worked example of the TORPEDO programme. BMC Med171) 233. doi:10.1186/s12916-019-1463-x