Page - 194 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

1. Introduction to the NASSS framework 1.1. Origins and overview of the NASSS framework Most research into technological innovations has focused on technology development and mapping patterns of adoption, with little attention paid to the systematic study of the non-adoption of promising technologies. This chapter introduces an evidence-based framework (abbreviated NASSS) for studying the non-adoption and abandonment of technologies by individuals and the challenges to scale-up, spread and sustainability of such technologies in health and care organizations. The NASSS framework was developed using two parallel processes: a narrative systematic review of theory-informed frameworks for analysing and evaluating technology-supported change programs in health and social care [1], and empirical testing and iterative refining of the NASSS domains using a diverse sample of technology implementation projects, written up as rich mixed-method case studies followed up for (at the time of writing) three years [2]. The NASSS framework is shown in Figure 1. It consists of seven domains, each of which may be simple (few components, predictable), complicated (many components but still largely predictable) or complex (many components interacting in a dynamic and unpredictable way). The more complexity there is in the system, the less likely the technology is to achieve sustained adoption across the system (and the more likely it is to be abandoned). The different sub-domains in the NASSS framework (right-hand panel in Figure 1) can be applied adaptively to produce a nuanced narrative that reveals the different kinds of complexity in the unfolding programme. Figure 1: The NASSS framework for studying non-adoption and abandonment of technologies by individuals and the challenges to scale-up, spread and sustainability of such technologies in health and care organisations (adapted from Greenhalgh et al [1]) T.GreenhalghandS.Abimbola /TheNASSSFramework–ASynthesisofMultipleTheories194