Why did we do the study?
The NoMAD (Normalization Measurement Development) is a 23-item tool that measures implementation. It is based on Normalization Process Theory. We used the NoMAD to understand how Health TAPESTRY became “normalized” into everyday clinical practice. Because it is a relatively new tool, in this we study described our experience using the NoMAD and contributed to measures to help validate use of this tool.
What did we do?
We asked health care providers involved with Health TAPESTRY at each primary care clinic to complete the NoMAD questionnaire six times over 12 months. Overall, 56 health care providers provided responses.
What did we find?
Experiences using the NoMAD: Using the NoMAD was time consuming. First, recruiting and reminding people to complete it was time consuming as well as subsequently compiling the results and reporting back to the teams. The NoMAD Results use a traffic light system (green = well normalized, yellow = somewhat normalized, and red = not normalized), which makes the results clear to understand and helps understand areas for attention, but took time for research staff to put together. We also added two more colours (dark red and light green) which helped show more subtle changes.
Our clinics’ NoMAD results: Generally, scores were higher 12-months later than they were at baseline, however the scores did not increase linearly.
Validating the NoMAD: The NoMAD has four subscales and three general questions. The internal consistency between them was satisfactory. All relationships between them except one were positive and most were statistically significant.
What do our findings mean?
We were able to use the NoMAD to further understand the implementation of Health TAPESTRY across sites.
We recommend that the NoMAD only be administered three times within a 1-year period: at early-, mid- and late-implementation. More time points are a burden on the administrators and respondents, especially in a busy health care setting.
We found that the NoMAD has satisfactory internal consistency and validity and is useful to assess implementation, however we caution others against solely using the NoMAD as it may miss aspects of normalization that may be captured better using other methods such as interviews or focus groups.
The full article can be found here:
Lamarche L, Clark RE, Parascandalo F, and Mangin D. The implementation and validation of the NoMAD during a complex primary care intervention. BMC Medical Research Methodology 22(1) 2022. https://doi.org/10.1186/s12874-022-01655-0