Intervention development: assessing critical parameters from the intervention recipient's perspective

doi:10.1016/j.apnr.2010.06.002

Applied Nursing Research

Volume 25, Issue 1, February 2012, Pages 31-39

https://doi.org/10.1016/j.apnr.2010.06.002 Get rights and content

Abstract

Before effective nursing interventions can be translated into practice, they must undergo critical examination. Although randomized controlled trials provide evidence of effectiveness, other intervention parameters require evaluation before effectiveness trials are initiated. This article describes methods for evaluating six parameters of nursing interventions (necessity, acceptability, feasibility, fidelity, safety, and effectiveness) and emphasizes the importance of assessing them from the intervention recipient's perspective.

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Citation Excerpt :
It is possible that some miscalculated their app usage or responded in a way that would be considered socially acceptable (Hróbjartsson, Emanuelsson, Skou Thomsen, Hilden, & Brorson, 2014). Objective assessments (e.g., average number of interactions, length of time of use) and adherence data (e.g., number of participants who complete each ‘session’ in its entirety), are needed to ensure more accurate presentation of app usage whilst also helping to identify the features associated with higher app engagement (Lee, Ahn, Nguyen, Choi, & Kim, 2017, Ng, Firth, Minen, & Torous, 2019; Zauszniewski, 2012). Several methodological issues were encountered in this review.
Smartphone applications (‘apps’) have the potential to improve the scalability of mental health interventions for young people, however, the effectiveness of stand-alone apps in mental health management remains unclear. This systematic review, with meta-analysis, provides an up-to-date summary of the available high-quality evidence.
Eleven randomized controlled trials, involving a pooled sample of 1706 adolescents and young adults (age range 10 to 35 years), were identified from the Cochrane Library, Embase, Google Scholar, PsycINFO and PubMed databases. The reporting quality of studies was evaluated using the Cochrane Risk of Bias Tool 2.0 (RoB 2.0). Hedges’ g effect sizes with 95% confidence intervals, p values and heterogeneity statistics were additionally calculated using a random effects model.
Study reporting quality was sound, with no trials characterized as ‘high’ risk. App interventions produced significant symptom improvement across multiple outcomes, compared to wait-list or attention control conditions (depression g_w = 0.52 [CI: 0.18–0.84], p = .01, k = 8; stress g_w = 0.30 [CI: 0.06–0.53], p = .02, k = 2). Longer-term benefits could not be established (k = 4), although individual studies reported positive trends up to 6 months post. Age was not identified as a significant moderator.
Smartphone apps hold promise as a stand-alone self-management tool in mental health service delivery. Further controlled trials with follow-up data are needed to confirm these findings as well as determine treatment engagement and effectiveness across diverse groups of participants.
Depression, positive thinking, personal and social resourcefulness among caregivers of persons with autism spectrum disorders
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Positive Thinking Training Intervention for Caregivers of Persons with Autism: Establishing Fidelity
2017, Archives of Psychiatric Nursing
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In developing an intervention to promote positive thinking in caregivers of persons with ASD, it is important to first establish that the intervention has adequate intervention fidelity. Fidelity of an intervention involves a competent delivery of the intervention that is in accordance with an outlined protocol (Zauszniewski, 2012). In other words, intervention fidelity indicates that the intervention is delivered as designed.
More than 3.5 million in the US are diagnosed with autism spectrum disorder (ASD) and caregivers experience stress that adversely affects their well-being. Positive thinking training (PTT) intervention can minimize that stress. However, before testing the effectiveness of PTT, its fidelity must be established. This pilot intervention trial examined fidelity of an online PTT intervention for ASD caregivers with a random assignment of 73 caregivers to either the online PTT intervention or to the control group. Quantitative data [Positive Thinking Skills Scale (PTSS)] and qualitative data (online weekly homework) were collected. The mean scores for the PTSS improved for the intervention group and decreased for the control group post intervention. Evidence for use of PTT was found in caregivers' online weekly homework. The findings provide evidence of the implementation fidelity of PTT intervention and support moving forward to test PTT effectiveness in promoting caregivers' well-being.
Caregiver coaching program effect: Reducing heart failure patient rehospitalizations and improving caregiver outcomes among African Americans
2015, Heart and Lung: Journal of Acute and Critical Care
Citation Excerpt :
At the end of each session, the caregivers were asked to describe what they learned. The nurse used an AHA home HF care checklist to list the skills learned and identify areas needing reinforcement.62 This teach-back technique monitored caregiver understanding of low-sodium diets, HF and depression symptoms reporting, advanced directives, and medication schedule.63,64
(1) Test whether FamHFcare intervention could reduce patients' heart failure (HF)-related rehospitalizations and improve family caregiver outcomes; (2) calculate effect size on caregiver outcomes; and (3) evaluate the FamHFcare.
Few interventions target family caregivers for HF home care.
This study was a mixed method design with stratification and random assignment of 20 African American HF patient/caregiver dyads. Descriptive, univariate parametric/non-parametric, and post-hoc analyses were used.
At 6 months, compared to standard care, the intervention group had significantly fewer HF rehospitalizations (M−W z = −1.8, p = 0.03), while caregiver confidence (M−W z = 2.8, p = 0.003) and social support scores (M−W z = 2.4, p = 0.01) were significantly higher, and caregiver depression (M−W z = −2.4, p = 0.01) were significantly lower. Caregivers rated the FamHFcare as helpful (M = 46.8 ± 4.1).
The FamHFcare intervention was associated with fewer HF patient rehospitalizations and improved caregiver outcomes.
The feasibility of a telephone coaching program on heart failure home management for family caregivers
2013, Heart and Lung: Journal of Acute and Critical Care
To test the feasibility of delivery and evaluate the helpfulness of a coaching heart failure (HF) home management program for family caregivers.
The few available studies on providing instruction for family caregivers are limited in content for managing HF home care and guidance for program implementation.
This pilot study employed a mixed methods design. The measures of caregiver burden, confidence, and preparedness were compared at baseline and 3 months post-intervention. Descriptive statistics were used to summarize program costs and demographic data. Content analysis research methods were used to evaluate program feasibility and helpfulness.
Caregiver (n = 10) burden scores were significantly reduced and raw scores of confidence and preparedness for HF home management improved 3 months after the intervention. Content analyses of nurse and caregiver post-intervention data found caregivers rated the program as helpful and described how they initiated HF management skills based on the program.
The program was feasible to implement. These results suggest the coaching program should be further tested with a larger sample size to evaluate its efficacy.
Group antenatal intervention to reduce perinatal stress and depressive symptoms related to intergenerational conflicts: A randomized controlled trial
2012, International Journal of Nursing Studies
Citation Excerpt :
The intervention targeted interpersonal issues identified in qualitative studies of Chinese women in the perinatal period, including intergenerational conflicts and role transitions (Chan and Levy, 2004; Leung et al., 2005). A careful assessment was done to determine the necessity and acceptability of the intervention (Zauszniewski, 2012). The intervention format and specific conflict issues were designed based on feedback from participants in 12 focus groups of pregnant and postnatal women as well as grandparents (Leung et al., 2009).
Intergenerational conflicts are a major source of stress, which might lead to depression in new mothers. The conflict is heightened when grandparents are involved in childcare.
To examine the effectiveness of an interpersonal psychotherapy oriented group intervention to reduce stress and depressive symptoms in new mothers and enhance happiness and self-efficacy in managing intergenerational conflict in childcare. This study is one of the intervention projects of FAMILY: A Jockey Club Initiative for a Harmonious Society, funded by The Hong Kong Jockey Club Charities Trust.
Multisite randomized controlled trial with two arms: an intervention group attended an additional 4-week program and a control group who received usual care only.
Six Maternal and Child Health Centres in Hong Kong
From September 2009 to January 2010, 156 pregnant women who would have grandparents involved in childcare were recruited at their 14–32 weeks’ gestation.
Participants were randomized to groups using computer generated random sequences by blinded recruitment staff. Primary outcomes were stress and depressive symptoms immediately after the intervention and 6–8 weeks after delivery. Secondary outcomes were happiness and self-efficacy in managing conflict.
After screening 2870 pregnant women, 156 eligible participants were randomized. Intention-to-treat analysis showed that the intervention group (n = 78) had significantly lower perceived stress (p = 0.017; Cohen d = 0.38) and greater happiness (p = 0.004; Cohen d = 0.41) than the control group (n = 78) immediately after the intervention. However, the effects were not sustained at postnatal follow-up. Subgroup analysis showed that participants with depressive symptoms (EPDS > 12) at baseline reported significantly lower stress, greater happiness (p = 0.035 and 0.037, respectively; both Cohen d = 0.61), greater self-efficacy in managing conflict (p = 0.012; Cohen d = 0.76) than the control group after the intervention. Also, after delivery, they had significantly greater self-efficacy in managing conflict (p = 0.025; Cohen d = 0.61) and more able to cooperate with grandparents in childcare (p = 0.046; Cohen d = 0.59) than the control group.
The intervention was effective in reducing stress and enhancing happiness among new mothers, particularly those with higher EPDS scores. Postnatal follow-up contacts as booster interventions may be needed to achieve lasting effects of the intervention.

View all citing articles on Scopus

^☆: The author acknowledges the editorial assistance of Elizabeth M. Tornquist of the University of North Carolina at Chapel Hill.

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Original ArticleIntervention development: assessing critical parameters from the intervention recipient's perspective☆

Abstract

Collegian

Journal of Substance Abuse Treatment

Diabetes Research and Clinical Practice

Explaining patient's beliefs about the necessity and harmfulness of antidepressants

Annals of Family Medicine

What can we learn from pilot studies?

Perspectives in Psychiatric Care

Enhancing treatment fidelity in health behavior change studies: Best practices and recommendations from the NIH Behavior Change Consortium

Health Psychology

The consolidated standards of reporting trials (CONSORT): Guidelines for reporting randomized trials

Nursing Research

Feasibility of an Internet activity intervention

Western Journal of Nursing Research

Cardiovascular risk assessment through target organ damage: Role of carotid femoral pulse wave velocity

Clinical and Experimental Pharmacology and Physiology

Enhancing hope among early female survivors of childhood cancer via the Internet: A feasibility study

Cancer Nursing

Cognitive–Behavioral intervention for hot flashes

Oncology Nursing Forum

Videoconferencing for delivery of breast cancer support groups to women in rural communities: A pilot study

Psycho-Oncology

Effects of a social support intervention on health outcomes in residents of a domestic violence shelter: A pilot study

Issues in Mental Health Nursing

Assessing patients' beliefs about cardiac rehabilitation as a basis for predicting attendance after acute myocardial infarction

Heart

Medication adherence skills training for middle-aged and elderly adults with bipolar disorder: Development and pilot study

Bipolar Disorder

Use of clients' self-reports to monitor Project Liberty clinicians' fidelity to a cognitive–behavioral intervention

Psychiatric Services

An effectiveness trial of cognitive behaviour therapy in a representative sample of outpatients with psychosis

British Journal of Clinical Psychology

Imagery intervention for recovering breast cancer patients: Clinical trial of safety and efficacy

Journal of the Society for Integrative Oncology

Tai chi-based exercise for older adults with Parkinson's disease: A pilot program evaluation

Journal of Aging and Physical Activity

Measuring participation in a prevention trial with parents of young children

Research in Nursing and Health

Musings on participation in health research and the recruitment process: It is not always about the numbers

Arthritis Care and Research

Original Article
Intervention development: assessing critical parameters from the intervention recipient's perspective☆