Background Projects to implement health care and social care innovations involving technologies are typically ambitious and complex. Many projects fail. Greenhalgh et al’s nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to analyze the varied outcomes of such projects. Objective We sought to extend the NASSS framework to produce practical tools for understanding, guiding, monitoring, and researching technology projects in health care or social care settings. Methods Building on NASSS and a complexity assessment tool (CAT), the NASSS-CAT tools were developed (in various formats) in seven co-design workshops involving 50 stakeholders (industry executives, technical designers, policymakers, managers, clinicians, and patients). Using action research, they were and are being tested prospectively on a sample of case studies selected for variety in conditions, technologies, settings, scope and scale, policy context, and project goals. Results The co-design process resulted in four tools, available as free downloads. NASSS-CAT SHORT is a taster to introduce the instrument and gauge interest. NASSS-CAT LONG is intended to support reflection, due diligence, and preliminary planning. It maps complexity through stakeholder discussion across six domains, using free-text open questions (designed to generate a rich narrative and surface uncertainties and interdependencies) and a closed-question checklist; this version includes an action planning section. NASSS-CAT PROJECT is a 35-item instrument for monitoring how subjective complexity in a technology implementation project changes over time. NASSS-CAT INTERVIEW is a set of prompts for conducting semistructured research or evaluation interviews. Preliminary data from empirical case studies suggest that the NASSS-CAT tools can potentially identify, but cannot always help reconcile, contradictions and conflicts that block projects’ progress. Conclusions The NASSS-CAT tools are a useful addition to existing implementation tools and frameworks. Further support of the implementation projects is ongoing. We are currently producing digital versions of the tools, and plan (subject to further funding) to establish an online community of practice for people interested in using and improving the tools, and hold workshops for building cross-project collaborations. International Registered Report Identifier (IRRID) DERR1-10.2196/16861

BACKGROUND Projects to implement health care and social care innovations involving technologies are typically ambitious and complex. Many projects fail. Greenhalgh et al’s nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to analyze the varied outcomes of such projects. OBJECTIVE We sought to extend the NASSS framework to produce practical tools for understanding, guiding, monitoring, and researching technology projects in health care or social care settings. METHODS Building on NASSS and a complexity assessment tool (CAT), the NASSS-CAT tools were developed (in various formats) in seven co-design workshops involving 50 stakeholders (industry executives, technical designers, policymakers, managers, clinicians, and patients). Using action research, they were and are being tested prospectively on a sample of case studies selected for variety in conditions, technologies, settings, scope and scale, policy context, and project goals. RESULTS The co-design process resulted in four tools, available as free downloads. NASSS-CAT SHORT is a taster to introduce the instrument and gauge interest. NASSS-CAT LONG is intended to support reflection, due diligence, and preliminary planning. It maps complexity through stakeholder discussion across six domains, using free-text open questions (designed to generate a rich narrative and surface uncertainties and interdependencies) and a closed-question checklist; this version includes an action planning section. NASSS-CAT PROJECT is a 35-item instrument for monitoring how subjective complexity in a technology implementation project changes over time. NASSS-CAT INTERVIEW is a set of prompts for conducting semistructured research or evaluation interviews. Preliminary data from empirical case studies suggest that the NASSS-CAT tools can potentially identify, but cannot always help reconcile, contradictions and conflicts that block projects’ progress. CONCLUSIONS The NASSS-CAT tools are a useful addition to existing implementation tools and frameworks. Further support of the implementation projects is ongoing. We are currently producing digital versions of the tools, and plan (subject to further funding) to establish an online community of practice for people interested in using and improving the tools, and hold workshops for building cross-project collaborations. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16861

Introduction: Health authorities across the world have implemented non-pharmaceutical interventions (NPIs) such as social distancing measures and hand hygiene campaigns in response to COVID-19. However, the adoption of health-protective behaviour by individuals in alignment with these interventions, although effective, is variable. Results: Evidence suggests that increases in perceived disease severity, disease susceptibility and intervention efficacy correlate with the adoption of protective behaviours. Additionally, external cues from select, credible sources promote behavioural adoption whilst barriers to behavioural change, such as the opportunity cost faced by the employed, dissuade adoption. Lastly, demographic and socioeconomic factors play a role with men, the young, those with lower educational status and those less socially connected being less likely to adopt protective behaviours. Conclusion: For health authorities, an understanding of these correlates can better inform efforts to increase adherence to NPIs and stem novel viral transmission. Approaches such as risk personalisation, the communication of evidence-based effects of interventions and education regarding lesserused behaviours (e.g., mask-wearing) are discussed. Also highlighted is the importance of consistent communication via local actors such as General Practitioners and the role of multilevel social networks. Lastly, the need for tailored efforts to enhance protective behaviour adoption in specific sub-populations is considered.

Background HIV prevention policy and program implementation rely heavily on cost-effectiveness studies. They involve the use of some uncertain variables, serving as proxies for complex, emergent and unpredictable scientific, social and behavioural issues. The ongoing implementation and scale-up of oral pre-exposure prophylaxis (PrEP) requires the improvement and refinement of cost-effectiveness calculations, and the measures on which they are based. Methods We conducted a framework synthesis of the literature on cost-effectiveness for oral PrEP for men who have sex with men (MSM) in the US and UK between 2009 and 2021. Results Reviewing how behavioural risk variables were used in the studies, we found both significant increases and decreases in projected risk behaviour in MSM starting PrEP, and limited use of evidence for these variables. Studies that included increased ‘risk compensation’ scenarios inferred quantitative estimates from qualitative measures, appeared to group risk variables with assumptions about low adherence, and projected estimates of increased HIV incidence associated with PrEP use. Conversely, studies that included lower risk behaviour cited related research about behavioural risk reduction associated with treatment-as-prevention and referenced discussions about the importance of changing risk behaviour, rather than empirical evidence of changed behaviour. Conclusion Increased accuracy of cost-effectiveness models can be achieved through refining the use of behavioural risk variables, including reference to a common evidence base.