JMIR Publications

ABSTRACT

Background:

The implementation of eMental health interventions (eMH) in routine healthcare constitutes a major challenge, and reliable instruments to assess implementation processes are lacking. The Normalisation MeAsure Development project (NoMAD) developed a 20-item self-report questionnaire to overcome this gap. Based on the Normalisation Process Theory, this instrument focuses on four generative mechanisms involved in implementation processes: Coherence, Cognitive Participation, Collective Action, and Reflexive MONITORING. A psychometric assessment of the original English version of NoMAD indicates that the theoretical model represented the data acceptably.

Objective:

We translated the NoMAD questionnaire to Dutch and studied the factor structure in Dutch mental healthcare settings.

Methods:

Dutch healthcare professionals involved in eMH implementation were invited to complete the NoMAD questionnaire. Confirmatory Factor Analysis (CFA) was conducted to verify interpretability of scale scores for three models: (1) the theoretical four-factor structure, (2) a unidimensional model, and (3) a hierarchical model. Potential improvements were identified exploratively, and correlated scale scores with three control questions were used to assess convergent validity.

Results:

313 healthcare professionals from mental healthcare settings completed the questionnaire (female: 77%; age: M = 46 ± 11). The internal consistency of the 20-item questionnaire was acceptable (.64 ≤ α ≤ .87). The theorised four-factor model and the hierarchical model fitted the data reasonably well in the CFA. The theorised four-factor model performed slightly better (CFI = .92, TLI = .90, RMSEA = .09, SRMR = .11, χ2diff = 25.21, p ≤ .05). Notwithstanding the significance, the difference is small and possibly not outweighing the practical relevance of a total score and sub-scale scores combined in one measurement model. One item was identified as weak (λCA.2 = .18). A moderate to strong convergent validity was found for two of the four sub-scales (.37 ≤ r ≤ .56, p ≤ .05).

Conclusions:

NoMAD’s theoretical factor structure was confirmed among mental healthcare professionals as meeting acceptable standards. The hierarchical model might prove useful in increasing the practical utility of the NoMAD questionnaire. The data suggests that NoMAD holds across service settings including Dutch mental healthcare. Future research should assess the questionnaire’s relative predictive value and responsiveness over time, and clarify the conceptual interpretability of the scale scores in implementation practices.