title: Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom.
abstract: OBJECTIVE
  To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program-a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being.
  
  
  METHODS
  Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit-led interviews at baseline/mid-point (n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings.
  
  
  RESULTS
  Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant.
  
  
  CONCLUSIONS
  The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care.
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Devlin
authors.affiliation: Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom.
authors.forename: Marilyn
authors.initials: M
authors.lastname: McGee-Lennon
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: O'Donnell
authors.affiliation: Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom.
authors.forename: Matt-Mouley
authors.initials: MM
authors.lastname: Bouamrane
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Ruth
authors.initials: R
authors.lastname: Agbakoba
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom School of Nursing, Midwifery and Social Work, University of Manchester, United Kingdom.
authors.forename: Siobhan
authors.initials: S
authors.lastname: O'Connor
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Grieve
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, United Kingdom.
authors.forename: Tracy
authors.initials: T
authors.lastname: Finch
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Sally
authors.initials: S
authors.lastname: Wyke
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Watson
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Susan
authors.initials: S
authors.lastname: Browne
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom frances.mair@glasgow.ac.uk.
authors.forename: Frances S
authors.initials: FS
authors.lastname: Mair
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D006284:Health Plan Implementation; D006801:Humans; D011320:Primary Health Care; D011446:Prospective Studies; D013222:State Medicine / Q000458:organization & administration; D017216:Telemedicine; D006113:United Kingdom
keywords: assistive living technologies; consumer health informatics; eHealth implementation; electronic health records; mHealth