The Swedish version of the Normalization Process Theory Measure S-NoMAD: translation, adaptation, and pilot testing

• Published in: Implementation Science
• Main Authors: Marie Elf, Sofi Nordmark, Johan Lyhagen, Inger Lindberg, Tracy Finch, Anna Cristina Åberg
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2018
• Subjects: Normalization process theory; NPT; Implementation; Questionnaire; Instrument development; Psychometric properties; Medicine (General); R5-920; Northern Sweden
• Online Access: https://doi.org/10.1186/s13012-018-0835-5; https://doaj.org/article/2bec849538194872a5f22c3d217af532

Abstract Background The original British instrument the Normalization Process Theory Measure (NoMAD) is based on the four core constructs of the Normalization Process Theory: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring. They represent ways of thinking about implementation and are focused on how interventions can become part of everyday practice. Aim To translate and adapt the original NoMAD into the Swedish version S-NoMAD and to evaluate its psychometric properties based on a pilot test in a health care context including in-hospital, primary, and community care contexts. Methods A systematic approach with a four-step process was utilized, including forward and backward translation and expert reviews for the test and improvement of content validity of the S-NoMAD in different stages of development. The final S-NoMAD version was then used for process evaluation in a pilot study aimed at the implementation of a new working method for individualized care planning. The pilot was executed in two hospitals, four health care centres, and two municipalities in a region in northern Sweden. The S-NoMAD pilot results were analysed for validity using confirmatory factor analysis, i.e. a one-factor model fitted for each of the four constructs of the S-NoMAD. Cronbach’s alpha was used to ascertain the internal consistency reliability. Results In the pilot, S-NoMAD data were collected from 144 individuals who were different health care professionals or managers. The initial factor analysis model showed good fit for two of the constructs (Coherence and Cognitive Participation) and unsatisfactory fit for the remaining two (Collective Action and Reflexive Monitoring) based on three items. Deleting those items from the model yielded a good fit and good internal consistency (alphas between 0.78 and 0.83). However, the estimation of correlations between the factors showed that the factor Reflexive Monitoring was highly correlated (around 0.9) with the factors Coherence and Collective Action. ...