Using normalisation process theory to evaluate the implementation of a digital health intervention in community and secondary care long COVID clinics
Using normalisation process theory to evaluate the implementation of a digital health intervention in community and secondary care long COVID clinics
Objectives: the potential and expected benefits of digital health interventions (DHI) have long been discussed, yet substantial challenges are associated with deploying DHI at scale. Insights are presented concerning the implementation of a DHI consisting of a patient- facing app and a digital dashboard for clinicians providing supported self- management for long COVID to support both clinicians and patients.
Design: qualitative reflexive thematic analysis, mapped against Normalisation Process Theory.
Setting: fifty- five and a half hours of zoom recordings of meetings between clinicians in community and secondary care long COVID clinics and members of the research team.
Participants: allied health professionals, service delivery managers and members of the core team, including representatives from industry partners.
Results: the DHI fitted with contextual circumstances and the design supported flexibility to suit circumstances in different trusts. The DHI also aligned with existing ways of working. Healthcare professionals worked together to support the implementation of the DHI, requiring flexibility to take account of local circumstances. The DHI was appraised in both positive and negative terms by healthcare professionals. Using DHIs was said to have the potential to complement care but not be a replacement for face- to- face clinical input. The DHI was judged to have demonstrated the potential to affect long- established patterns and organisational structures of engagement between healthcare professionals and patients in terms of access to care.
Conclusions: NPT provided a framework for considering both individual agency and the organisation context, enabling reflections to be made at the level of the structure of services as well as people’s experiences. The discipline of considering first the context, then the work and finally the practical effects helped place order on the ‘mess’ involved in the rapid cycle of developing, refining and implementing a DHI in an atypical environment (a pandemic)
Stevenson, Fiona A.
881eb2a9-d7a8-449d-be50-ead6fda5cd3e
Pfeffer, Paul
27b22a6f-c29a-4d81-9635-b5dff591716f
Walker, Sarah
40d315ef-ffb5-4b75-9d29-b5c05a1d2581
Ismaila, Hadiza
699f66b0-b077-4afa-9d33-195170287a95
Jegatheesan, Vinosh
71a2df49-f133-422f-8f3a-0d26bcceabd1
Mohammad, Ibrahim
45b9540c-26b0-420f-b9a2-5947d8fb7a78
Blandford, Ann
1a959d23-6ce2-41bd-89ea-b81b61ec5f7a
Linke, Stuart
1c79b2cc-1e16-4b44-a104-d6b76154258f
Hurst, John
6798076d-b1c5-4a42-95fb-8c48742abf38
Ricketts, William
f16390fa-ba59-4f6b-8d6c-43ac41de5c9d
Hamilton, Fiona L.
3ed5bd8f-5cbd-468e-bf0b-9886b87ad89e
Sunkersing, David
848c46be-b9ec-4086-8d66-67284dd67602
Bradbury, Katherine
87fce0b9-d9c5-42b4-b041-bffeb4430863
Goodfellow, Henry
8d655992-8e49-451b-ab83-a57523694b32
27 November 2024
Stevenson, Fiona A.
881eb2a9-d7a8-449d-be50-ead6fda5cd3e
Pfeffer, Paul
27b22a6f-c29a-4d81-9635-b5dff591716f
Walker, Sarah
40d315ef-ffb5-4b75-9d29-b5c05a1d2581
Ismaila, Hadiza
699f66b0-b077-4afa-9d33-195170287a95
Jegatheesan, Vinosh
71a2df49-f133-422f-8f3a-0d26bcceabd1
Mohammad, Ibrahim
45b9540c-26b0-420f-b9a2-5947d8fb7a78
Blandford, Ann
1a959d23-6ce2-41bd-89ea-b81b61ec5f7a
Linke, Stuart
1c79b2cc-1e16-4b44-a104-d6b76154258f
Hurst, John
6798076d-b1c5-4a42-95fb-8c48742abf38
Ricketts, William
f16390fa-ba59-4f6b-8d6c-43ac41de5c9d
Hamilton, Fiona L.
3ed5bd8f-5cbd-468e-bf0b-9886b87ad89e
Sunkersing, David
848c46be-b9ec-4086-8d66-67284dd67602
Bradbury, Katherine
87fce0b9-d9c5-42b4-b041-bffeb4430863
Goodfellow, Henry
8d655992-8e49-451b-ab83-a57523694b32
Stevenson, Fiona A., Pfeffer, Paul, Walker, Sarah, Ismaila, Hadiza, Jegatheesan, Vinosh, Mohammad, Ibrahim, Blandford, Ann, Linke, Stuart, Hurst, John, Ricketts, William, Hamilton, Fiona L., Sunkersing, David, Bradbury, Katherine and Goodfellow, Henry
(2024)
Using normalisation process theory to evaluate the implementation of a digital health intervention in community and secondary care long COVID clinics.
BMJ Open, 14 (11), [e092824].
(doi:10.1136/bmjopen-2024-092824).
Abstract
Objectives: the potential and expected benefits of digital health interventions (DHI) have long been discussed, yet substantial challenges are associated with deploying DHI at scale. Insights are presented concerning the implementation of a DHI consisting of a patient- facing app and a digital dashboard for clinicians providing supported self- management for long COVID to support both clinicians and patients.
Design: qualitative reflexive thematic analysis, mapped against Normalisation Process Theory.
Setting: fifty- five and a half hours of zoom recordings of meetings between clinicians in community and secondary care long COVID clinics and members of the research team.
Participants: allied health professionals, service delivery managers and members of the core team, including representatives from industry partners.
Results: the DHI fitted with contextual circumstances and the design supported flexibility to suit circumstances in different trusts. The DHI also aligned with existing ways of working. Healthcare professionals worked together to support the implementation of the DHI, requiring flexibility to take account of local circumstances. The DHI was appraised in both positive and negative terms by healthcare professionals. Using DHIs was said to have the potential to complement care but not be a replacement for face- to- face clinical input. The DHI was judged to have demonstrated the potential to affect long- established patterns and organisational structures of engagement between healthcare professionals and patients in terms of access to care.
Conclusions: NPT provided a framework for considering both individual agency and the organisation context, enabling reflections to be made at the level of the structure of services as well as people’s experiences. The discipline of considering first the context, then the work and finally the practical effects helped place order on the ‘mess’ involved in the rapid cycle of developing, refining and implementing a DHI in an atypical environment (a pandemic)
Text
e092824.full
- Version of Record
More information
Accepted/In Press date: 27 October 2024
e-pub ahead of print date: 27 November 2024
Published date: 27 November 2024
Identifiers
Local EPrints ID: 504822
URI: http://eprints.soton.ac.uk/id/eprint/504822
ISSN: 2044-6055
PURE UUID: 4f3ce5fa-1e3c-4ff7-91f0-74372f6cdbfb
Catalogue record
Date deposited: 19 Sep 2025 16:34
Last modified: 20 Sep 2025 01:50
Export record
Altmetrics
Contributors
Author:
Fiona A. Stevenson
Author:
Paul Pfeffer
Author:
Sarah Walker
Author:
Hadiza Ismaila
Author:
Vinosh Jegatheesan
Author:
Ibrahim Mohammad
Author:
Ann Blandford
Author:
Stuart Linke
Author:
John Hurst
Author:
William Ricketts
Author:
Fiona L. Hamilton
Author:
David Sunkersing
Author:
Henry Goodfellow
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics