Chapter 28 Developing Complex Nursing Interventions Using Mixed Methods Research

Question #1

Tell whether the following statement is true or false:

Nursing intervention research refers to a distinctive process of developing, implementing, testing, and disseminating nursing interventions.

Answer to Question #1

True

Nursing intervention research refers to a distinctive process of developing, implementing, testing, and disseminating nursing interventions—particularly complex interventions.

Nursing Intervention Research #1

Distinctive process

Developing, implementing, testing, and disseminating nursing interventions

Particularly complex interventions

Nursing Intervention Research #2

Complex intervention

The number of different behaviors required by those delivering or receiving the intervention, and the difficulty level of those behaviors

The number of different groups or organizational levels targeted by the intervention

The number and diversity of intervention outcomes targeted

The degree to which the intervention can be tailored to individual patients

Nursing Intervention Research #3

Frameworks for developing and testing complex interventions

Phase 1: Development

Phase 2: Feasibility and piloting

Phase 3: Evaluation

Phase 4: Implementation

Question #2

Tell whether the following statement is true or false:

Studies to assess effectiveness of interventions in real-world clinical settings (Phase 4) are common in nursing.

Answer to Question #2

False

Studies to assess effectiveness of interventions in real-world clinical settings (Phase 4) are rare in nursing.

Nursing Intervention Research #4

Key features of complex intervention research

Strong support for mixed methods approaches

Coordinated teamwork

Ongoing, dedicated program

Patient and public involvement (PPI)

Nursing Intervention Research #5

Desirable features of nursing interventions:

Salient

Efficacious

Conceptually sound

Cost-effective

Feasible

Developmentally appropriate

Culturally sensitive

Accessible

Acceptable

Adaptable

Readily disseminated

Question #3

Tell whether the following statement is true or false:

An important product during Phase 2 is a carefully conceived intervention theory from which the design of the intervention flows.

Answer to Question #3

False

An important product during Phase 1 is a carefully conceived intervention theory from which the design of the intervention flows.

Phase 1: Intervention Development #1

Key issues

Conceptualization of the problem

Understanding of current practices and why they are deficient

Articulation of an evidence base for the intervention

Conceptualization of the context

Conceptualization of solutions, strategies, and outcomes

Construct validation of the intervention

Identification of potential pitfalls within the implementation context

Cultivation of relationships

Phase 1: Intervention Development #2

Major activities

Critical synthesis of relevant literature

Concept and theory development

Exploratory and descriptive research

Consultation with experts; content validation

Brainstorming with colleagues, team building, partnerships with stakeholders

Modeling and designing the intervention

Phase 1: Intervention Development #3

Products and outcomes

An intervention theory

Preliminary specification of the content, intensity, dose, timing, setting, and delivery method of the intervention

Preliminary identification of key outcomes

Strategies to overcome pitfalls in implementing and testing the intervention

An implementation plan

A design for a pilot study

A plan for sponsorship of the pilot study

Phase 1: Intervention Development #4

Intervention theory

Dose and intensity

Timing

Outcomes to target and when to measure them

Setting

Agents

Mode of delivery

Individualization

Phase 2: Pilot Testing an Intervention

Feasibility

Acceptability

Pilots

Qualitative components

Recruitment and retention

Feasibility of more rigorous testing

Lessons

Refine the intervention

Improve its acceptance and appeal

Enhance delivery

Phase 3: Evaluation of the Intervention

Full test of intervention using a randomized design

Assessing efficacy

Assessing intervention fidelity

Clarifying the intervention

Understanding the context

Probing for clinical significance

Interpreting results

Summary report

Phase 4: Implementation

Implementation

Normalization process theory (NPT)

A measure called NoMAD (Normalization MeAsure Development)

Question #4

Tell whether the following statement is true or false:

A mixed methods approach can strengthen the test of the intervention during the Phase 2 controlled trial.

Answer to Question #4

False

A mixed methods approach can strengthen the test of the intervention during the Phase 3 controlled trial. The inclusion of qualitative components can shed light on intervention fidelity, variation in effects, clinical significance, and interpretive ambiguities.

Mixed Methods Designs for Intervention Research

Appropriate for all phases

Phase 1 QUAL has priority.

Phases 2 and 3 QUAN are usually dominant.