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Table 1 Summary of empirical case studies and data sources (adapted from J Med Internet Res. 2017; 19: e367)

From: Analysing the role of complexity in explaining the fortunes of technology programmes: empirical application of the NASSS framework

Study site(s)



Data sources

Case A. Video outpatient consultations

 A1: Acute hospital trust (3 specialties — diabetes, antenatal, cancer — on different sites)

 A2: Nurse-led heart failure service run from community hospital

Skype™ (acute hospital) and FaceTime™ (community hospital) together with commercially available blood pressure and heart rate monitors, weighing scales and oximeter

A1: 24 staff (9 clinicians, 10 support staff, 5 managers); 27 patients

A2: 10 staff (8 nurses, one manager, one administrator); 8 patients

Plus 48 national stakeholders and wider informants on remote consulting

35 formal semi-structured interviews plus ~ 100 informal interviews; 150+ hours of ethnographic observation; 40 videotaped remote consultations (12 diabetes, 6 antenatal diabetes, 12 cancer, 10 heart failure); 500+ emails; 30 local documents, e.g. business plans, protocols; 50 national-level documents

Case B. GPS tracking for cognitive impairment

 Social care organisation in deprived borough in inner London

GPS tracking devices supplied by 5 different technology companies, includes GPS tracking with virtual map and ‘geo-fence’ alert functions

7 index cases; 8 lay carers; 5 formal carers, 3 social care staff; 3 healthcare staff; 3 call centre staff

22 ethnographic visits and ‘go-along’ interviews with index cases (~ 50 h); 15 ethnographic visits with health and social care staff; 6 staff interviews; 5 team meetings; 3 local protocols

Case C. Pendant alarms

 C1: Healthcare commissioning organisation in deprived borough in outer London

 C2: Social care organisation in mixed borough in the Midlands

In both sites, pendant alarms and base units were supplied by multiple different technology companies and supported by local councils, each with a different set of arrangements with providers and an ‘arms-length management organisation’ alarm support service

C1: 8 index cases; 7 lay carers; 12 professional staff

C2: 11 index cases; 9 health/social care staff from frontline service delivery to senior board level; 3 representatives from telecare industry

50 semi-structured and narrative interviews; 61 ethnographic visits (~ 80 h of observation) including needs assessments and reviews; 20 h of observation at team meetings

Case D. Remote biomarker monitoring in heart failure

 Acute hospital trusts in six different cities in UK

Tablet computer and Bluetooth-enabled commercially available sensing devices (blood pressure and heart rate monitor, weighing scales)

7 research staff including principal investigator and research coordinator for SUPPORT-HF trial; 7 clinical staff involved in trial; 4 clinical staff not involved in trial; (to date) 18 patient participants and one spouse

1 patient focus group; 8 patient interviews; 24 additional semi-structured interviews; SUPPORT-HF study protocol and ethics paperwork; material properties and functionality of biomarker database

Case E. Care organising software

 E1: Healthcare commissioning organisation in northern England

 E2: National carer support charity in UK

Product A: Web-based portal developed by small tech company for use by families to help them organise and coordinate the care of (typically) an older relative

Product B: Smartphone app co-designed by carer support charity for same purpose

Product A: 2 technology developers and CEO of technology company; 4 social care commissioners; 30 health and social care staff considering using the device; 4 users of the device, one non-user

Product B (to date): 2 members of care charity (including CEO); 10 qualitative case studies of users undertaken by another academic team

22 semi-structured and narrative interviews; 16 h ethnographic observations of meetings; auto-ethnographic testing of functionality and usability of devices; secondary analysis of 3rd party evaluation of Product B

Case F. Data warehouse for integrated case management

 1 acute hospital trust, 1 community health trust, 3 local councils, 3 healthcare commissioning organisations

Integrated data warehouse incorporating predictive risk modelling (in theory interoperable with record systems in participating organisations)

14 staff; 20 patient participants

14 semi-structured interviews; 50 ethnographic visits (~ 80 h); 12 h shadowing community staff; 4 h observation of interdisciplinary meetings; 12 local protocols/documents