Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies.
Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies.
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DOI：
10.2196/jmir.8775
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发表时间：
2017-11-01
影响因子：
7.4
通讯作者：
Shaw S
中科院分区：
文献类型：
--
作者：
Greenhalgh T;Wherton J;Papoutsi C;Lynch J;Hughes G;A'Court C;Hinder S;Fahy N;Procter R;Shaw S
健康和社会保健领域许多有前途的技术创新的特点是不被个人采用或放弃，或者在本地扩大规模、远程传播或在组织或系统层面长期维持创新的尝试失败。我们的目标是建立一个基于证据、理论指导和务实的框架，以帮助预测和评估技术支持的健康或社会护理计划的成功。该研究有两个并行组成部分：(1) 二次研究（解释学系统回顾），以确定关键领域；(2) 技术实施的实证案例研究，以探索、测试和完善这些领域。我们在 20 多个组织中使用纵向民族志和行动研究长达 3 年的时间，研究了 6 个技术支持的项目——视频门诊咨询、认知障碍全球定位系统跟踪、悬挂报警服务、心力衰竭远程生物标志物监测、护理组织软件以及通过数据共享进行的综合病例管理。数据是在微观层面（个人技术用户）、中观层面（组织流程和系统）和宏观层面（国家政策和更广泛的背景）收集的。分析和综合得到了有关个人、组织和系统变革的社会技术理论的帮助。该框架草案与正在介绍或评估其他技术支持的健康或护理计划的同事共享，并根据反馈进行了完善。文献综述确定了 28 个先前的技术实现框架，其中 14 个采用了动态系统方法（包括 2 个对先前工作的综合综述）。我们的实证数据集包括 400 多个小时的民族志观察、165 次半结构化访谈和 200 份文档。最终的不采用、放弃、扩大、传播和可持续性 (NASSS) 框架包括 7 个领域的问题：状况或疾病、技术、价值主张、采用者系统（包括专业人员、患者和非专业护理人员）、组织、更广泛的（机构和社会）背景以及所有这些领域之间随着时间的推移的相互作用和相互适应。我们的实证案例研究在所有 7 个领域提出了各种挑战，每个领域都分为简单（直接、可预测、组件少）、复杂（多个相互作用的组件或问题）或复杂（动态、不可预测、不易分解为组成组件）。事实证明，以复杂为特征的计划很难实施，但并非不可能实施。那些在多个 NASSS 领域具有复杂性的特征很少（如果有的话）成为主流。该框架在（前瞻性和回顾性）应用于其他项目时显示出前景。经过进一步的实证测试，NASSS 可以应用于健康和社会护理领域的一系列技术创新。它有几个潜在的用途：（1）为新技术的设计提供信息； (2) 找出（也许尽管有政策或行业热情）实现大规模、持续采用机会有限的技术解决方案； (3) 规划技术项目的实施、扩大或推出； (4) 解释程序失败并从中吸取教训。
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. 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. 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. 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. Subject to further empirical testing, NASSS could be applied across a range of technological innovations in health and social care. It has several potential uses: (1) to inform the design of a new technology; (2) to identify technological solutions that (perhaps despite policy or industry enthusiasm) have a limited chance of achieving large-scale, sustained adoption; (3) to plan the implementation, scale-up, or rollout of a technology program; and (4) to explain and learn from program failures.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.1016/j.ijmedinf.2013.10.009
发表时间：
2014-07-01
影响因子：
4.9
作者：
Abbott, Patricia A.;Foster, Joanne;Dykes, Patricia C.
通讯作者：
Dykes, Patricia C.
影响因子：
3.2
作者：
Atun, Rifat;de Jongh, Thyra;Adeyi, Olusoji
通讯作者：
Adeyi, Olusoji
影响因子：
7.3
作者：
DAVIS, FD
通讯作者：
DAVIS, FD
影响因子：
5.7
作者：
CHERNS, A
通讯作者：
CHERNS, A