title: From theory to 'measurement' in complex interventions: methodological lessons from the development of an e-health normalisation instrument.
abstract: BACKGROUND
  Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field.
  
  
  METHODS
  A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals.
  
  
  RESULTS
  The developed instrument was pre-tested in two professional samples (N=46; N=231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.
  
  
  CONCLUSIONS
  To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study.
authors.affiliation: Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne, NE2 4AX, England. Tracy.Finch@ncl.ac.uk
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Finch
authors.forename: Frances S
authors.initials: FS
authors.lastname: Mair
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Donnell
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murray
authors.forename: Carl R
authors.initials: CR
authors.lastname: May
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D004059:Diffusion of Innovation; D006302:Health Services Research; D006801:Humans; D008962:Models, Theoretical; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D036301:Qualitative Research; D013673:Technology Assessment, Biomedical; D017216:Telemedicine / Q000295:instrumentation*; D014584:User-Computer Interface