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Egbunike-Agbakoba, Ruth Ngozika Ifunanya Obianuju (2019) Factors Affecting the Implementation of a National Digital Health &

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Egbunike-Agbakoba, Ruth Ngozika Ifunanya Obianuju (2019) Factors Affecting the Implementation of a National Digital Health & Egbunike-Agbakoba, Ruth Ngozika Ifunanya Obianuju (2019) Factors Affecting the Implementation of A National Digital Health & Wellbeing Service at Scale. PhD thesis. https://theses.gla.ac.uk/74308/ Copyright and moral rights for this work are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This work cannot be reproduced or quoted extensively from without first obtaining permission in writing from the author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Enlighten: Theses https://theses.gla.ac.uk/ [email protected] FACTORS AFFECTING TH E IMPLEMENTATION OF A N A T I O N A L DIGITAL HEALTH & WEL LBEING SERVICE A T S C A L E PhD THESIS Submitted to the University of Glasgow, Institute of Health and Wellbeing in the fulfilment of the requirements for the degree of Doctor of Philosophy Ruth Ngozika Ifunanya Obianuju Egbunike – Agbakoba BSc. Biomedical Informatics, 1st Class Honours (2009), MSc Health Informatics (2010) Specialism: Primary Care Informatics – MRC DTP Scholarship Award (2012 – 2016) Visiting Scholar Fellowship, Principal Award, McGill University, Canada. (2016 – 2017) Department of General Practice & Primary Care Copyright © September 2018 CONTENTS PAGE PUBLICATIONS….………….....………………..………….…………………………..………….…………………………………………………….. 7 ACKNOWLEDGEMENTS….………….....………………..………….…………………………..………….……………………………………….. 11 SPECIAL MENTION……………………………………………………………………………………………………………………………………….. 12 AUTHORS DECLARATION...……….....…………………..………….…………………………..………….……………………………………… 13 ABBREVIATIONS…….…………........……………..………….…………………………..………….……………………………………………….. 14 LIST OF FIGURES………….…….…...……………..………….…………………………..………….………………………………………………… 15 LIST OF TABLES………..………………………..………….…………………………..………….…………………...................................... 16 CHAPTER ONE: Introduction……………………………..…………….....……………………………............................................... 17 1.1 Background: Digital Health and Population Ageing……….……………………………….…………………………............... 17 1.2 Statement of the Problem: Importance of Implementation Research…………….……………………………........... 18 1.3 UK and Scottish Policy Context……......………………………………….…………………………….……............................... 19 1.4 Shaping the Future of Health and Wellbeing……………………………………………................................................ 20 1.5 Research Aims and Objectives…………………………………………………………………………………............................... 21 1.6 Research Design and Methods….……………………………………………………………………………….............................. 21 1.7 Original Contribution Sought……………………………………………………………………………………............................... 22 1.8 PhD Thesis Structure…………………………………………………………….…………………….............................................. 22 CHAPTER TWO: Structured Literature Review……………...…………..……...…..…..………............................................ 24 2.1 Introduction……………………………………………...…………………………………………………………………………………………… 24 2.2 Search Strategy – Identification of Sources…………...…………………………………………………………....................... 24 2.3 Inclusion and Exclusion Criteria for considering studies for Review…………...………………………………............. 25 2.3.1 Inclusion Criteria…………..…………………………………………………………...................................................... 26 2.3.2 Exclusion Criteria……………………………………………………………………………………………………………………….. 26 2.4 Charting Data ………………………………………....……………………………….................................................................. 28 2.5 Results – Collating, Summarizing and Reporting Findings …………....………………………………………………………. 28 2.5.1 Descriptive Statistics…………………………………………………………………………….......................................... 28 2.5.2 Thematic Analysis………………………………………………………………………………............................................ 29 2.5.2.1 Organizational Factors…………………………….……………………………………………………..................................... 29 2.5.2.1.1 Organizational Readiness and Planning: Ready, Set Go? ……………………………………...................... 30 2.5.2.1.2 Start-up Education and Training…………………………………………………………………………………………….. 30 2.5.2.1.3 Leadership and Management: Planning, Vision & Implementation Approach………………………… 32 2.5.2.1.4 Start-up Resources: Man-power, time and finances……………………………………………………............. 34 2.5.2.1.5 Organisational Cultures: Communication and Relationships…………………………………………………… 34 2.5.2.2 Human and Social Factors…….……………………………………………………………………….................................... 35 2.5.2.2.1 Patient & Consumer Engagement……………………… ……………………………………................................. 35 2.5.2.2.2 Impact on Working Practices & Routines ……………………………………………………………………………….. 37 2.5.2.2.3 Clinical Champions…………………………………………………………….……………………………………………………. 38 2.5.2.2.4 Impact on Patient Outcomes……………………………………………………………………………......................... 38 2.5.2.3 Political Factors…….……………………………………………………………………………………....................................... 39 2.5.2.4 Economic Factors…….……………………………………………………………………….................................................. 40 2.5.2.5 Technical Factors…………………………….……………………………….…………………………...................................... 41 2.5.2.5.1 Interoperability and Standardization Issues ……………………………………........................................... 41 2.5.2.5.2 Usability and User Satisfaction………………………………………………………………………….......................... 42 2.5.2.5.3 Infrastructure: Internal and External Factors ……...……………………………............................................... 43 2.5.2.5.4 Privacy and Security Issues…..…………………………………………………………………………................................. 43 2.6 Discussion……………………………………………………………………………………………………………………………………………. 44 2.6.1 NPT: Coherence Domain (‘Making Sense’ of Digital Health Initiatives)….…………………………….................. 45 2.6.2 NPT: Cognitive Participation Domain ……………………..……………………………………………….............................. 45 2.6.3 NPT: Collective Action Domain (Operationalising Work)……………………………………………………………………… 46 2.6.4 NPT: NPT: Reflexive Monitoring Domain (Appraisal work)…………………………………………………………………… 48 2.6.5 Strengths and Limitations…………………………………………………………………………………………………………………… 48 2.7 Conclusions & Key Evidence Gaps…………………………………………………………………………………………………………. 48 CHAPTER THREE: Introduction……………………………..…………….....……………………………........................................... 71 3.2 Section One: Theoretical Component of the Study………………………………..………………………………………….. 72 3.2.1 Determining the underpinning Theoretical Framework for the Study……………………………………………. 72 3.2.2 Exploration of Theories used to Evaluate Implementation Science……………………………………………………… 73 3.2.2.1 Strong Structuration Theory (SST)………………………………………………………………………………………………. 73 3.2.2.2 Diffusion of Innovation Theory (DOI)………………………………………………………………………………………… 73 3.2.2.3 Actor Network Theory (ANT)………………………………………………………………………………………………………. 74 3.2.2.4 Theory of Planned Behaviour (TPB)……………………………………………………………………………………………. 74 3.2.2.5 Normalisation Process Theory (NPT)………………………………………………………………………………………….. 74 3.2.3 Critique of Theoretical Frameworks & Decision-Making……………………………………………………………………… 75 3.2.4 How NPT Can Help Overcome Existing Theoretical Limitations…………………………………………………………… 76 3.2.4.1 Benefits and Disadvantages of the Approach…………………………………………………………………………….. 77 3.3 Section Two: Philosophical Component of the Study……………………………………………………………………………… 78 3.3.1 Ontological & Epistemological Considerations………………………………………………………………………………. 78 3.3.2 Research Paradigm: Interpretivist & Qualitative Nature………………………………………………………………… 79 3.3.3 Research Approach: Use of Deductive and Inductive Research Approach…………………………………….. 79 3.3.4 Research Strategy: Single Explanatory Case Study………………………………………………………………………… 80 3.3.5 Strengths vs. Limitations of Case Study Research………………………………………………………………………….. 80 3.4 Section Three: Practical Component of the Study…………………………………………………………………………….. 81 3.4.1 Sampling and Recruitment of Participants (Key Informants)………………………………………………………….. 81 3.4.2 Data Collection: Multi-Method Qualitative Study…………………………………………………………………………… 82 3.4.2.1 Ethnography and Participant Observation (Shadowing)……………………………………………………… 82 3.4.2.2 Documentary Evidence………………………………………………………………………………………………………. 86 3.4.2.3 Semi-Structured Interviews and Sit-In Focus Group…………………………………………………………… 87 3.4.3 Data Saturation……………………………………………………………………………………………………………………………… 88 3.4.4 Research Governance – Data Recording, Storage and Training……………………………………………………… 89 3.4.5 Data Analysis – Transcription & Procedural Steps………………………………………………………………………….. 89 3.4.6 Content Analysis: Thematic Analysis (Richie & Spencer Framework)…………………………………………….. 90 3.4.6.1 Familiarisation with the Data………………………….………………………………………………………………….. 90 3.4.6.2 Identification of Framework: Priori Codes & Challenges…………………………………………………….. 90 3.4.6.3 Indexing of Transcripts……………………………………………………………………………………………………….. 91 3.4.6.4 Charting the Data Excerpts……………………………………………………………………………………………….. 91 3.4.6.5 Mapping to NPT as an Explanatory Framework [Interpretation]………………………………........... 91 3.5 Ethical Considerations –Privacy and Security…………………………………………………………………………………………. 91 3.5.1 Consent…………………………………………………………………………………………………………………………………………. 93 3.5.2 Confidentiality & Anonymity ………………………………………………………………………………………………………… 93 3.6 Role of the Researcher…………………………………………………………………………………………………………………………… 93 3.6. 1 Project Challenges: Dynamic Real World………………...…………………………………….................................
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