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

• DOI: 10.2196/jmir.8775
• Publication Date: 2017-11-01T10:45:10Z
• Authors: Trisha Greenhalgh; Joseph Wherton; Chrysanthi Papoutsi; Jennifer Lynch; Gemma Hughes; Christine A'Court; Susan Hinder; Nick Fahy; Rob Procter; Sara Shaw
• Keywords: Health Technology

Background: Many promising technological innovations in health and social care are characterized by nonadoption or abandonment individuals failed attempts to scale up locally, spread distantly, sustain the innovation long term at organization system level. Objective: Our objective was produce an evidence-based, theory-informed, pragmatic framework help predict evaluate success of a technology-supported program. Methods: The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) identify key domains, (2) empirical case studies technology implementation explore, test, refine these domains. We studied 6 programs—video outpatient consultations, global positioning tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring heart failure, organizing software, integrated management via data sharing—using longitudinal ethnography action 3 years across more than 20 organizations. Data were collected micro level (individual users), meso (organizational processes systems), macro (national policy wider context). Analysis synthesis aided sociotechnically informed theories individual, organizational, change. draft shared with colleagues who introducing evaluating other programs refined response feedback. Results: literature review identified 28 previous frameworks, which 14 taken dynamic systems approach (including integrative reviews work). dataset consisted over 400 hours ethnographic observation, 165 semistructured interviews, 200 documents. final nonadoption, abandonment, scale-up, spread, sustainability (NASSS) included questions 7 domains: condition illness, technology, value proposition, adopter (comprising professional staff, patient, lay caregivers), organization(s), (institutional societal) context, interaction mutual adaptation between all domains time. raised variety challenges each classified as simple (straightforward, predictable, few components), complicated (multiple interacting components issues), complex (dynamic, unpredictable, not easily disaggregated into constituent components). Programs complicatedness proved difficult but impossible implement. Those complexity multiple NASSS rarely, if ever, became mainstreamed. showed promise when applied (both prospectively retrospectively) programs. Conclusions: Subject further testing, could be range care. It has several potential uses: inform design new technology; solutions that (perhaps despite industry enthusiasm) have limited chance achieving large-scale, sustained adoption; (3) plan implementation, rollout program; (4) explain learn from program failures.