Page - 180 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

2. Use of NPT in health informatics and service development Having given an overview of NPT, we will now explore how the theoryhas been applied in both prospective planning, as well as ongoing and retrospective evaluation of implementations in health informatics contexts. We will examine two examples from published literature: firstly, an example of prospective planning of a digital healthcare intervention for management of diabetes [10,11]; and secondly an evaluation of implementation of a new electronic preoperative information system within a surgical pre-assessment clinic [12]. These two cases will serve as examples of how NPT has been used to plan and evaluate successful implementation of new health informatics systems, and identify mechanisms involved in this process. 2.1. Prospective planning of an evaluation study on implementation of a digital health intervention for Type-2 diabetes Effective self-management is essential to good health outcomes and the prevention of associated complications for people with type 2 diabetes [10]. The UK National Institute for Heath and Clinical Excellence (NICE) recommends structured education to teach self-management; however, evidence suggests that only a small proportion of patients are offered this service, with fewer eventually attending [10]. Ross et al. developed an internet based self-management intervention: “HeLP-Diabetes: Healthy Living for People with Type 2 Diabetes”, allowing patients to access self-management measures recorded by their GP surgeries, as well as information resources based on NICE guidance designed to complement existing in-person group education programme [10]. In planning implementation of HeLP-Diabetes, Ross et al. needed to consider how they would: determine uptake and use of the intervention by services and patients; identify factors promoting or restricting use; identify resources needed for successful implementation; and explore possible intervention effects on self-reported patient outcome measures [10]. The authors used NPT as an explanatory framework to explore the implementation process and guide interviews with NHS staff, using constructs and components as sensitizing resources (i.e. as indicators of general processes and kinds of work relevant to the outcomes of interest) [10]. Data collection also included informal feedback from staff at GP practices, collected by one researcher leading the implementation, as well as usage data from the HeLP-Diabetes software on number of patients signing up and the GP practices at which they were registered [11]. Ross et al. used NPT in analysis of interview, feedback, and usage data to develop an implementation plan for HeLP-Diabetes, in which specific implementation strategies were developed to target challenges mapped to the main constructs of NPT (see table 1). Coherence-related strategies included identifying key people within the local Clinical Commissioning Group (CCG – the body responsible for commissioning of services locally) as well as GP practice managers and leads [11]. This strategy allowed for targeted provision of educational materials emphasizing HeLP-Diabetes as an online system distinct from other self-management programmes, and its status as a free-to-use resource developed by a university. These strategies helped support Differentiation between HeLP-Diabetesand existing resources, and Internalizationof value by drawing attention to its lack of cost to users, and the legitimacy of the developing body [11]. The implementation team also held educational outreach visits with healthcare professionals (HCPs) in which the nature of the programme, its evidence base, theoretical basis, M.BracherandC.R.May / ImplementingandEmbeddingHealth InformaticsSystems180