Technology identities explain under- and non-adoption of community-based point-of-care tests in the UK NHS

Objectives: This study applies the concept of 'technology identities' to explain non-adoption and alleged under-adoption of a number of technologies in the NHS. Methods: As part of a qualitative comparative case study of (non)adoption of eight device technologies using in-depth stakeholder interviews and documentary analysis, we compared two point-of-care test (POCT) technologies: C-reactive protein (CRP) to rule out bacterial infection in acute cough in primary care, and near-patient (NPT) or self-testing of blood coagulation (INR) for patients taking warfarin. We draw on an explanatory model we have developed, the 'adoption space', encompassing multiple influences (political, social, technical, evidential and structural) and actors, within and outside the NHS and the construct of 'technology identity'. Results: Both technologies were supported by formal evidence but were either not used at all (CRP) or not as widely as might be expected (coagulometer). CRP testing was not attractive due to a weak utility identity coupled with high financial and pragmatic requirements. NPT for anticoagulation had been adopted primarily because its requirement for widespread organisational change enabled the redesign of dysfunctional services. Self-testing for INR had not been encouraged by healthcare professionals or commissioners due to its perceived high clinical risk and doubt about patients[U+05F3] capability, but this was changing somewhat as its clinical effectiveness identity became more prominent. Conclusions: Technology identities (attributes that healthcare technologies acquire in the course of often contested deliberations about adoption) shape the pathway that (non)adoption takes; the concept can be used to explain and manage adoption and non-adoption.