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).