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Design, Evaluation,
and Translation of
Nursing Interventions
P1:OTA/XYZ P2:ABC
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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
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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
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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
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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
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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
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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
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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
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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
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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.
