"If We Got a Win-Win, You Can Sell It to Everybody": A Qualitative Study Employing Normalization Process Theory to Identify Critical Factors for eHealth Implementation and Scale-up in Primary Care.

OBJECTIVES:Translation of eHealth research findings and successful implementation into clinical care is limited. We used a multitiered approach (individual, organizational, societal) to assess the implementation potential of MyDiabetesPlan within Ontario's primary care system and applied the normalization process theory (NPT) to explicate our findings. METHODS:Data were collected from 15 individuals through interviews with primary care administrative end-users and a focus group discussion with Ministry of Health decision-makers, then qualitatively analyzed using thematic analysis for emergent themes. RESULTS:We identified 3 themes corresponding to our multitiered approach: 1) stakeholder buy-in was critical to engagement and was impacted by perceptions/capacities; 2) clinical integration of MyDiabetesPlan depended on alignment with clinic philosophy of care, pre-existing technologies and workflow; and 3) political climate and trends were important considerations for eHealth implementation. Application of NPT to findings revealed that interplay between buy-in and perceptions/capacities of clinical practice stakeholders was critical to engaging them for eHealth implementation. In contrast, evaluation of costs and outcomes was critical to inform operational-management stakeholders' perceptions. Findings at the organizational and societal levels best aligned with the factors influencing operationalization of MyDiabetesPlan. Overall, our findings show that the synergistic operationalization of MyDiabetesPlan into practice was a prerequisite to implementation at all health-care levels. CONCLUSIONS:Application of NPT revealed context- and stakeholder-specific interactions that should be synergistically leveraged to promote MyDiabetesPlan normalization into routine clinical practice. Our findings provide further insight into how researchers can comprehensively assess eHealth implementation potential within Ontario and can be extrapolated to similar single-payer health-care jurisdictions.