NoMAD Study

The NoMAD study developed a 23 item instrument for measuring implementation processes from the perspective of professionals directly involved in the work of implementing complex interventions in healthcare. The 20 core construct items organised by NPT construct can be viewed. The full instrument can be downloaded here.

The aim of NoMAD was to develop an instrument containing implementation assessment items reflecting the constructs of NPT, and to validate it in a range of settings where complex interventions were being implemented. A full description of the study protocol can be found here. The full study results will be forthcoming.

The development methods included several iterative rounds of item generation, consensus workshops, cognitive (‘think aloud’) interviews, item quality appraisal and theory validation by expert critique.

A 46 item instrument was tested through surveys of participants implementing six different implementation projects, resulting in 831 survey responses for validation analyses.

The final 23 item instrument was achieved through analysis of psychometrics and other information about response patterns, and agreed by the project team using item ranking and consensus methods.

Here is some guidance on how to use the NoMAD instrument.

Citing NoMAD

The NoMAD instrument should be cited as:

Finch, T.L., Girling, M., May, C.R., Mair, F.S., Murray, E., Treweek, S., Steen, I.N., McColl, E.M., Dickinson, C., Rapley, T. (2015). NoMAD: Implementation measure based on Normalization Process Theory. [Measurement instrument]. Retrieved from