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dc.contributor.authorGreenhalgh, Trisha
dc.contributor.authorWherton, Joe
dc.contributor.authorPapoutsi, Chrysanthi
dc.contributor.authorLynch, Jennifer
dc.contributor.authorHughes, Gemma
dc.contributor.authorA'Court, Christine
dc.contributor.authorHinder, Sue
dc.contributor.authorFahy, Nick
dc.contributor.authorProcter, Rob
dc.contributor.authorShaw, Sara
dc.date.accessioned2017-11-06T15:54:44Z
dc.date.available2017-11-06T15:54:44Z
dc.date.issued2017-11-01
dc.identifier.citationGreenhalgh , T , Wherton , J , Papoutsi , C , Lynch , J , Hughes , G , A'Court , C , Hinder , S , Fahy , N , Procter , R & Shaw , S 2017 , ' Beyond adoption: A new framework for theorising and evaluating Non-adoption, Abandonment and challenges to Scale-up, Spread and Sustainability (NASSS) of health and care technologies ' , Journal of Medical Internet Research , vol. 19 , no. 11 , e367 . https://doi.org/10.2196/jmir.8775
dc.identifier.issn1439-4456
dc.identifier.otherPURE: 12512851
dc.identifier.otherPURE UUID: 96e97ede-2a8d-4b0e-a45b-935cbf467985
dc.identifier.otherScopus: 85034861727
dc.identifier.urihttp://hdl.handle.net/2299/19495
dc.description© 2017 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
dc.description.abstractBackground: Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level. Objective: Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program. Methods: The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs—video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing—using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback. Results: The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology, the value proposition, the adopter system (comprising professional staff, patient, and lay caregivers), the organization(s), the wider (institutional and societal) context, and the interaction and mutual adaptation between all these domains over time. Our empirical case studies raised a variety of challenges across all 7 domains, each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components or issues), or complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs characterized by complicatedness proved difficult but not impossible to implement. Those characterized by complexity in multiple NASSS domains rarely, if ever, became mainstreamed. The framework showed promise when applied (both prospectively and retrospectively) to other programs.en
dc.format.extent21
dc.language.isoeng
dc.relation.ispartofJournal of Medical Internet Research
dc.rightsOpen
dc.subjectdiffusion of innovation
dc.subjectscale-up
dc.subjectprogram sustainability
dc.subjectimplementation
dc.subjectcomplexity of innovations
dc.subjectbusiness planning
dc.subjectNASS framework
dc.subjectnon-adoption
dc.subjectabandonment
dc.subjectspread
dc.subjectsustainability framework
dc.subjectinnovation adoption
dc.titleBeyond adoption: A new framework for theorising and evaluating Non-adoption, Abandonment and challenges to Scale-up, Spread and Sustainability (NASSS) of health and care technologiesen
dc.contributor.institutionCentre for Research in Public Health and Community Care
dc.contributor.institutionSchool of Health and Social Work
dc.contributor.institutionOlder People's Health and Complex Conditions
dc.description.statusPeer reviewed
dc.relation.schoolSchool of Health and Social Work
dc.description.versiontypeFinal Published version
dcterms.dateAccepted2017-11-01
rioxxterms.versionVoR
rioxxterms.versionofrecordhttps://doi.org/10.2196/jmir.8775
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue
herts.rights.accesstypeOpen


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