Assessing Intervention Parameters: Understanding Perspectives and Enhancing Evidence-Based Practice

1. Intervention Development: Assessing Critical Parameters from the Intervention Recipient’s Perspective Jaclene A. Zauszniewski, PhD, RN-BC, FAAN Kate Hanna Harvey Professor Associate Dean for Doctoral Education

2. OBJECTIVES • Identify six parameters to be examined during intervention development • Explain the importance of including intervention recipients in evaluating interventions • Cite examples of how the six intervention parameters have been systematically examined through research Intervention Development Assessing Critical Parameters

3. INTRODUCTION • Research is needed to support evidence-based practice • Value of pilot studies – important information is gained before pursuing larger clinical trial • Importance of including intervention recipient in the process of intervention development Intervention Development Assessing Critical Parameters

4. INTERVENTION PARAMETERS Acceptability Feasibility Intervention Parameters Necessity Fidelity Effectiveness Safety Intervention Development Assessing Critical Parameters

5. NECESSITY • Refers to whether or not one believes he or she needs the intervention • Perspectives: • Medical / health care professional • Intervention recipient Intervention Development Assessing Critical Parameters

6. NECESSITY • Examples • Prescription of antidepressants • (Aikens, Nease, & Klinkman, 2008) • Cardiac rehabilitation program • (Cooper, Wineman, Hankins, Jackson, & Horne, 2007) • Parent training classes • (Garvey, Julion, Fogg, Kratovil, & Gross, 2006) Intervention Development Assessing Critical Parameters

7. ACCEPTABILITY • Refers to whether or not a person believes that what he or she is being asked to do is reasonable or appropriate • Aspects: intervention itself; delivery method; intervention provider • Perspectives: • Intervention provider • Observer • Intervention recipient Intervention Development Assessing Critical Parameters

8. ACCEPTABILITY • Examples • Relaxation training & activity • (Rabin, Pinto, Dunsige, Nash, & Trask, 2009) • Brief motivational interviewing • (Horn, Dino, Hamilton, Noerachmanto, 2008) • Advance care planning • (Lyon, Garvie, Briggs, He, McCarter, & D’Angelo, 2009) Intervention Development Assessing Critical Parameters

9. FEASIBILITY • Refers to whether or not one believes that what he or she is being asked to do is manageable and practical • Differs from feasibility of recruitment, time commitment of intervention providers, or intervention delivery method • Perspectives: • Intervention provider • Intervention recipient Intervention Development Assessing Critical Parameters

10. FEASIBILITY • Examples • Tai-chi based exercise • (Fuzhong, Harmer, Fisher, Xu, Fitzgerald, & Vongjaturapat, 2007) • Advance care planning • (Lyon, Garvie, Briggs, He, McCarter, & D’Angelo, 2009) • Relaxation training & activity • (Rabin, Pinto, Dunsige, Nash, & Trask, 2009) Intervention Development Assessing Critical Parameters

11. FIDELITY • Competent delivery of the intervention that adheres to a prescribed protocol • Important for psychosocial interventions that are flexible, tailored, or individualized • Strategies: intervention protocol; checklists • Perspectives: • Researcher • Intervention provider • Observer • Intervention recipient Intervention Development Assessing Critical Parameters

12. FIDELITY • Examples • Psychoeducation intervention • (Lara, Navarro, Acevedo, Berenzon, Mondragon, & Rubi, 2004) • Body-oriented therapy intervention • (Price, McBride, Hyerle, & Kivlahan, 2007) • Curriculum-based illness management • (Salyers, Godfrey, McGuire, Gearhart, Rollins, & Boyle, 2009) Intervention Development Assessing Critical Parameters

13. SAFETY • Requires that the intervention does not cause physical harm or mental distress to intervention recipients • Perspectives: • Intervention provider • Intervention recipient • Researcher • Monitoring board Intervention Development Assessing Critical Parameters

14. SAFETY • Examples • Prescription of antidepressants • (Aikens, Nease, & Klinkman, 2008) • Home-based exercise intervention • (Krousel-Wood, Berger, Jiang, Blonde, Myers, & Webber, 2008) • Advance care planning intervention • (Lyon, Garvie, Briggs, He, McCarter, & D’Angelo, 2009) Intervention Development Assessing Critical Parameters

15. EFFECTIVENESS • Determined by comparison between persons who receive the intervention and those who do not • Differs from efficacy; conducted in the “real world” • Perspectives” • Researcher • Observer • Intervention recipient Intervention Development Assessing Critical Parameters

16. EFFECTIVENESS • Examples • Comprehensive psychoeducation • (Thomas & Looney, 2004) • Social support intervention • (Constantino, Kim, & Crane, 2005) • Group therapy intervention • (Seamore, Buckroyd, & Stott, 2006) Intervention Development Assessing Critical Parameters

17. CONCLUSION • Critical need to evaluate all 6 intervention parameters before moving forward • Input and feedback from intervention recipients are essential • Findings regarding effectiveness of interventions may be confounded • Knowledge of 6 parameters will inform further intervention development Intervention Development Assessing Critical Parameters

18. REFERENCE Zauszniewski, J.A., (In press). Intervention development: Assessing critical parameters from the intervention recipient’s perspective. Applied Nursing Research, (e-pub available online at www.sciencedirect.com). Intervention Development Assessing Critical Parameters