Design, Evaluation, and Translation of Nursing Interventions PDF
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P1:OTA/XYZ P2:ABC BLBS083-fm BLBS083-Sidani July1,2011 10:51 Trim:244mm×172mm Design, Evaluation, and Translation of Nursing Interventions P1:OTA/XYZ P2:ABC BLBS083-fm BLBS083-Sidani July1,2011 10:51 Trim:244mm×172mm Design, Evaluation, and Translation of Nursing Interventions Souraya Sidani, PhD ProfessorandCanadaResearchChair HealthIntervention:DesignandEvaluation SchoolofNursing RyersonUniversity Toronto,Ontario,Canada Carrie Jo Braden, PhD, RN, FAAN ProfessorandAssociateDeanforResearch HughRoyCullenProfessorofNursing SchoolofNursing TheUniversityofTexasHealthScienceCenteratSanAntonio SanAntonio,Texas,US A John Wiley & Sons, Ltd., Publication P1:OTA/XYZ P2:ABC BLBS083-fm BLBS083-Sidani July1,2011 10:51 Trim:244mm×172mm Thiseditionfirstpublished2011(cid:2)C 2011byJohnWiley&Sons,Inc. Wiley-BlackwellisanimprintofJohnWiley&Sons,formedbythemergerofWiley’sglobal Scientific,TechnicalandMedicalbusinesswithBlackwellPublishing. Registeredoffice: JohnWiley&SonsLtd,TheAtrium,SouthernGate,Chichester, WestSussex,PO198SQ,UK Editorialoffices: 2121StateAvenue,Ames,Iowa50014-8300,USA TheAtrium,SouthernGate,Chichester,WestSussex,PO198SQ,UK 9600GarsingtonRoad,Oxford,OX42DQ,UK Fordetailsofourglobaleditorialoffices,forcustomerservicesandforinformationabout howtoapplyforpermissiontoreusethecopyrightmaterialinthisbookpleaseseeour websiteatwww.wiley.com/wiley-blackwell. Authorizationtophotocopyitemsforinternalorpersonaluse,ortheinternalorpersonal useofspecificclients,isgrantedbyBlackwellPublishing,providedthatthebasefeeispaid directlytotheCopyrightClearanceCenter,222RosewoodDrive,Danvers,MA01923.For thoseorganizationsthathavebeengrantedaphotocopylicensebyCCC,aseparatesystem ofpaymentshasbeenarranged.ThefeecodesforusersoftheTransactionalReporting ServiceareISBN-13:978-0-8138-2032-3/2011. Designationsusedbycompaniestodistinguishtheirproductsareoftenclaimedas trademarks.Allbrandnamesandproductnamesusedinthisbookaretradenames,service marks,trademarksorregisteredtrademarksoftheirrespectiveowners.Thepublisherisnot associatedwithanyproductorvendormentionedinthisbook.Thispublicationisdesigned toprovideaccurateandauthoritativeinformationinregardtothesubjectmattercovered.It issoldontheunderstandingthatthepublisherisnotengagedinrenderingprofessional services.Ifprofessionaladviceorotherexpertassistanceisrequired,theservicesofa competentprofessionalshouldbesought. LibraryofCongressCataloging-in-PublicationData Sidani,Souraya. Design,evaluation,andtranslationofnursinginterventions/SourayaSidani, CarrieJoBraden. p.;cm. Includesbibliographicalreferencesandindex. ISBN-13:978-0-8138-2032-3(pbk.:alk.paper) ISBN-10:0-8138-2032-4(pbk.:alk.paper) 1.Nursing–Research. I.Braden,CarrieJo,1944– II.Title. [DNLM:1.NursingCare. 2.EvaluationStudiesasTopic. 3.NursingResearch. 4.ResearchDesign. 5.TranslationalResearch. WY100.1] RT81.5.S562011 610.73072–dc23 2011014378 AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Thisbookispublishedinthefollowingelectronicformats:ePDF9780470961506; ePub9780470961513;Mobi9780470961520 Setin9/12.5ptInterstateLightbyAptara(cid:2)R Inc.,NewDelhi,India Disclaimer Thepublisherandtheauthormakenorepresentationsorwarrantieswithrespecttothe accuracyorcompletenessofthecontentsofthisworkandspecificallydisclaimall warranties,includingwithoutlimitationwarrantiesoffitnessforaparticularpurpose.No warrantymaybecreatedorextendedbysalesorpromotionalmaterials.Theadviceand strategiescontainedhereinmaynotbesuitableforeverysituation.Thisworkissoldwith theunderstandingthatthepublisherisnotengagedinrenderinglegal,accounting,orother professionalservices.Ifprofessionalassistanceisrequired,theservicesofacompetent professionalpersonshouldbesought.Neitherthepublishernortheauthorshallbeliablefor damagesarisingherefrom.ThefactthatanorganizationorWebsiteisreferredtointhis workasacitationand/orapotentialsourceoffurtherinformationdoesnotmeanthatthe authororthepublisherendorsestheinformationtheorganizationorWebsitemayprovide orrecommendationsitmaymake.Further,readersshouldbeawarethatInternetWebsites listedinthisworkmayhavechangedordisappearedbetweenwhenthisworkwaswritten andwhenitisread. 12011 P1:OTA/XYZ P2:ABC BLBS083-fm BLBS083-Sidani July1,2011 10:51 Trim:244mm×172mm Contents Preface xi Acknowledgment xiii SECTION1 INTRODUCTION 1 IntroductiontoInterventionResearch 3 1.1 Overviewofparadigmshift 4 1.1.1 Evidence-basedpractice:areview 5 1.1.2 Client-centeredcare 7 1.1.3 High-qualitycareredefined 9 1.2 Processfordesigning,evaluating,andtranslating interventions 11 1.2.1 Designofinterventions 11 1.2.2 Evaluationofinterventions 12 1.2.3 Translationofinterventions 13 1.3 Overviewofthebook 14 SECTION2 DESIGNINGINTERVENTIONS 2 OverviewofDesigningInterventions 17 2.1 Nursinginterventionsdefined 17 2.1.1 Definitionofinterventions 17 2.1.2 Characteristicsofinterventions 19 2.2 Presentingproblems 21 2.2.1 Definitionofproblem 21 2.2.2 Characteristicsofproblems 21 2.3 Designofinterventions 23 3 UnderstandingtheProblem 27 3.1 Theoreticalapproachforunderstandingtheproblem 27 3.2 Empiricalapproachforunderstandingtheproblem 31 3.3 Experientialapproachforunderstandingtheproblem 35 3.4 Combinedapproachforunderstandingtheproblem 40 3.5 Theoryoftheproblem 42 v P1:OTA/XYZ P2:ABC BLBS083-fm BLBS083-Sidani July1,2011 10:51 Trim:244mm×172mm vi Contents 4 ClarifyingElementsoftheIntervention 43 4.1 Theory-basedapproachfordesigninginterventions 43 4.2 Empiricalapproachfordesigninginterventions 49 4.3 Experientialapproachfordesigninginterventions 53 4.3.1 Focusgroup 53 4.3.2 Conceptmapping 54 4.3.3 Assessmentoftreatmentpreferences 54 4.4 Specificationofinterventions 56 4.4.1 Interventiongoals 56 4.4.2 Interventioncomponentsandactivities 56 4.4.3 Interventionmodeofdelivery 57 4.4.4 Interventiondose 59 5 InterventionTheory 61 5.1 Delineationofinterventionoutcomes 61 5.2 Interventiontheory 64 5.2.1 Structure 64 5.2.2 Process 68 5.2.3 Outcome 68 5.3 Utilityofinterventiontheory 71 6 TailoredIntervention 73 6.1 Designoftailoredinterventions 74 6.1.1 Interventiontheory 74 6.1.2 Identificationofclientcharacteristicsfor tailoring 75 6.1.3 Assessmentofclientcharacteristics 76 6.1.4 Constructionofalistofinterventionstrategies 76 6.1.5 Developmentofalgorithm 78 6.2 Effectivenessoftailoredinterventions 81 6.3 Mechanismsunderlyingeffectsoftailoredinterventions 82 SECTION3 IMPLEMENTATIONOFINTERVENTIONS 7 OverviewofImplementationofInterventions 85 7.1 Variationsininterventionimplementation 85 7.2 Consequencesofvariationsinintervention implementation 90 7.3 Strategiestoenhanceinterventionimplementation 91 8 DevelopmentofInterventionManual 93 8.1 Procedurefordevelopingtheinterventionmanual 93 8.1.1 Contextualcharacteristics 94 8.1.2 Process 94 P1:OTA/XYZ P2:ABC BLBS083-fm BLBS083-Sidani July1,2011 10:51 Trim:244mm×172mm Contents vii 8.2 Contentoftheinterventionmanual 95 8.2.1 Section1:overviewoftheintervention 95 8.2.2 Section2:humanandmaterialresources 97 8.2.3 Section3:procedure 100 8.3 Useoftheinterventionmanual 108 9 Selecting,Training,andAddressingtheInfluence ofInterventionists 111 9.1 Traditionalperspectiveoninterventionistinfluence 112 9.2 Interventionistinfluence:theevidence 113 9.3 Selectionofinterventionists 116 9.4 Trainingofinterventionists 119 9.5 Methodologicalfeaturesofstudiesaimedat investigatinginterventionisteffects 123 10 InterventionFidelity 125 10.1 Definitionoffidelity 125 10.2 Methodsformonitoringfidelity 129 10.2.1 Theoreticalfidelity 130 10.2.2 Operationalfidelity 133 10.3 Importanceofmonitoringfidelityofintervention implementation 143 SECTION4 EVALUATIONOFINTERVENTIONS 11 OverviewofEvaluationofInterventions 149 11.1 Criteriaforinferringcausality 149 11.2 Phasesforinterventionevaluation 154 11.2.1 Phase1 154 11.2.2 Phase2 155 11.2.3 Phase3 158 11.2.4 Phase4 160 11.3 Roleofinterventiontheory 161 12 TestingtheAcceptabilityandFeasibility ofInterventions 163 12.1 Acceptabilityofinterventions 164 12.1.1 Conceptualizationofinterventionacceptability 165 12.1.2 Operationalizationofinterventionacceptability 167 12.2 Feasibilityofinterventions 180 12.2.1 Definitionoffeasibility 180 12.2.2 Indicatorsoffeasibility 181 12.3 Feasibilityofresearchmethods 185 12.3.1 Recruitmentprocedures 186 12.3.2 Screening 188 P1:OTA/XYZ P2:ABC BLBS083-fm BLBS083-Sidani July1,2011 10:51 Trim:244mm×172mm viii Contents 12.3.3 Randomization 189 12.3.4 Retention 191 12.3.5 Datacollection 192 12.4 Designofpilotstudy 193 13 ExaminingtheEfficacyofInterventions 197 13.1 Factorsaffectingthecausalrelationshipbetween interventionandoutcomes 198 13.1.1 Conceptualfactors 198 13.1.2 Methodologicalfactors 200 13.1.3 Addressingconceptualandmethodological factors 201 13.2 Designfeaturesofanefficacystudy 201 13.2.1 Carefulselectionofparticipants 219 13.2.2 Controlofexperimentalcondition 222 13.2.3 Selectionofcomparisongroup 223 13.2.4 Allocationofparticipantstogroups 228 13.2.5 Standardizedtreatmentimplementation 230 13.2.6 Outcomemeasurement 231 13.2.7 Outcomedataanalysis 231 14 DeterminingtheEffectivenessofInterventions 233 14.1 Efficacyversuseffectiveness:Abriefreview 234 14.2 LimitationsoftheRCTdesignineffectivenessresearch 235 14.2.1 Unrepresentativenessofthesample 235 14.2.2 Highlyselectsetting 236 14.2.3 Limitedapplicabilityofinterventions 237 14.2.4 Irrelevanceofcomparisontreatment 238 14.2.5 Limitedutilityofrandomization 239 14.2.6 Limitedrelevanceoffindings 240 14.3 Alternativedesignsforevaluatingeffectiveness 241 14.3.1 Overallfunctionorgoal 241 14.3.2 Broadrepresentativesample 241 14.3.3 Selectionofdifferentsettings 242 14.3.4 Comparisonofclinicallyrelevantalternative treatments 242 14.3.5 Assessmentofrelevanthealthoutcomesat follow-up 243 14.3.6 Allocationtotreatment 243 14.3.7 Additionalfeatures 245 15 PreferencesforTreatment 251 15.1 Conceptualizationoftreatmentpreferences 251 15.1.1 Factorsinfluencingtreatmentpreferences 252 15.1.2 Consequencesoftreatmentpreferences 253 P1:OTA/XYZ P2:ABC BLBS083-fm BLBS083-Sidani July1,2011 10:51 Trim:244mm×172mm Contents ix 15.2 Mechanismsunderlyinginfluenceoftreatment preferencesininterventionresearch 254 15.2.1 Influenceoftreatmentpreferencesonexternal validity 254 15.2.2 Influenceoftreatmentpreferencesoninternal validity 256 15.2.3 Researchdesignsaccountingfortreatment preferences 258 SECTION5 TRANSLATIONOFINTERVENTIONS 16 TranslationofInterventions 263 16.1 Systematicreviewofevidence 264 16.2 Translationofevidence 265 16.3 Transferofguidelinetopractice 268 16.3.1 Adaptationofguideline 268 16.3.2 Disseminationandimplementationofguideline 270 References 271 Index 295 P1:OTA/XYZ P2:ABC BLBS083-FMBM BLBS083-Sidani June21,2011 16:8 Trim:244mm×172mm Preface Provisionofhigh-qualitycaretopersonswithdifferenthealthproblemsrests on the delivery of interventions that are appropriate and effective in ad- dressingthepresentingproblem.Interventionsaresubjectedtoasystematic processconsistingoffourphases,beforemakingthemavailableforuseinthe contextofday-to-daypractice. Thefirstphaserelatestothecarefuldesignofinterventions,whichisbased onacomprehensiveunderstandingofthepresentingproblemandthedevel- opmentofinterventionsthattargettheproblem.Theacquiredknowledgeis synthesized into an intervention theory that clarifies the nature of the tar- getedproblem;identifiestheactiveingredients,modeofdelivery,anddoseof theintervention;andexplainsthemechanismsunderlyingtheintervention’s effects on the intended outcomes. The second phase focuses on the oper- ationalization of the intervention into an intervention manual. The manual detailsthehumanandmaterialresourcesrequiredtodelivertheintervention, as well as the specific actions or steps undertaken to carry out the inter- vention. The manual directs the actual implementation and assessment of the fidelity of the intervention implementation. The third phase consists of aseriesofconsecutivestudiesforinvestigatingtheacceptability,feasibility, efficacy, and effectiveness of the intervention. To be relevant to practice, thestudies’resultsshouldindicatewhichclients,presentingwithwhichper- sonalandhealthorclinicalcharacteristics,benefit,towhatextent,fromthe intervention delivered in what mode and at what dose, under what context. Thefourthphaseinvolvesthetranslationoftheintervention.Translationen- tailsthetransformationofthestudies’resultsintomeaningfulguidelinesand thetransferoftheguidelinestohealthcareprofessionalswhoareultimately responsibleforprovidingtheinterventionintheirday-to-daypractice. Althoughthesystematicprocesshasbeendelineated,therearelimitedre- sourcesavailabletoinformnursesandotherhealthcareprofessionalsofthe generalapproachesandspecificmethodsfordesigning,evaluating,andtrans- latinginterventions.Thisbookisconcernedwithdescribingthephasesofthe systematic process and clarifying what is to be achieved, and how, in each phase.Itisintendedtoserveasahelpful“one-step”referenceforhealthcare professionals planning to engage in this process. The content of the book coversconceptual,methodological,andpracticalknowledgeneededtocarry outeachphase.Theconceptualknowledgeclarifiestheaspectsoftheprob- lem that should be understood to guide the development of interventions; the active ingredients of the intervention that are responsible for inducing xi P1:OTA/XYZ P2:ABC BLBS083-FMBM BLBS083-Sidani June21,2011 16:8 Trim:244mm×172mm xii Preface thedesiredchangesinthepresentingproblem;themechanismsunderpinning the intervention effects on the intended outcomes; and the definition and indicators of the acceptability, feasibility, efficacy, and effectiveness of the intervention. The methodological knowledge presents different but comple- mentaryapproachesfordesigningandevaluatinginterventions.Theprinciples underlyingeachapproachareexplainedanditsstrengthsandlimitationsare discussed.Thepracticalknowledgeentailsdetaileddescriptionofthemethods andproceduresforcarryingouttheapproachesineachphaseoftheprocess. Thegoalistosupportstudents,researchers,andhealthcareprofessionals in the careful design, systematic evaluation, and meaningful translation of interventions,and,consequently,intheprovisionofhigh-qualitycare.
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