Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework
The NASSS Framework helps understand why health technologies succeed or fail in real-world settings. It looks at seven areas—such as the illness, the technology, the people using it, and the broader system—to predict whether a technology will be adopted, used long-term, or spread across different settings. It emphasizes that when challenges are highly complex across multiple areas, success is unlikely.
At a glance
Use when
Designing, planning, or evaluating the implementation, scale-up, or sustainability of health or social care technologies, especially when facing persistent adoption challenges or complex system dynamics.
Avoid when
When a quick, checklist-style assessment is needed without in-depth qualitative or systems analysis, or when dealing with highly standardized, low-complexity technologies in stable environments.
Inputs
Information on the health condition, technology design, stakeholder values, adopter characteristics, organizational structures, policy context, and interdependencies across domains.
Outputs
Assessment of implementation feasibility, classification of challenges as simple, complicated, or complex, and guidance on whether a technology is likely to be adopted, sustained, or scaled.
How it works
The NASSS Framework is an evidence-based, theory-informed tool developed through a hermeneutic systematic review and empirical case studies across six technology-supported health and care programs. It comprises seven domains: the condition or illness, the technology, the value proposition, the adopter system (professionals, patients, caregivers), the organization(s), the wider context, and the dynamic interaction and mutual adaptation across domains over time. Each domain is assessed for simplicity, complicatedness, or complexity. The framework supports prospective and retrospective analysis of technology implementation, scale-up, spread, and sustainability, particularly in sociotechnical systems where multiple interdependent factors influence outcomes.
- HTA domains
- Organisational aspects
- Categories
- Context & Implementation
- Assumptions
- Successful technology implementation depends on alignment and adaptation across multiple interdependent domains; complexity in more than one domain significantly reduces the likelihood of long-term success.
- Strengths
- Comprehensive, multi-level analysis covering individual, organizational, and societal factors,Distinguishes between simple, complicated, and complex challenges to guide appropriate responses,Informed by both literature and longitudinal empirical data from diverse case studies,Applicable prospectively (for planning) and retrospectively (for evaluation)
- Limitations
- Does not provide specific implementation actions or solutions for identified challenges,Requires expert judgment to assess complexity across domains,May be resource-intensive to apply fully due to breadth of domains and data needs
- Also known as
- NASSS Framework, NASSS
Questions this answers
- › Why do some health technologies fail to be adopted or sustained despite their promise?
- › What factors make scaling up or spreading a health technology difficult?
- › How can complexity across different system levels affect technology implementation?
- › Which domains should be assessed when planning technology rollout in health or social care?
- › When is a technology likely to fail due to complex interactions between users, organizations, and context?
- › How can stakeholders anticipate and respond to nonadoption or abandonment of digital health tools?
References & sources
Similar by meaning
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