2.50
Hdl Handle:
http://hdl.handle.net/10755/211543
Type:
Research Study
Title:
ASSESSING THE FIDELITY OF THE HEALTH EMPOWERMENT INTERVENTION
Abstract:
Intervention fidelity in a randomized controlled trial (RCT) reflects  the degree to which an interventionist adheres to the protocal specific to the treatment. However, assessment of treatment fidelity is often overlooked when conducting a RCT, limiting the ability to rule out alternative explainations for intervention effects. Aims: The purpose of this paper is to describe  how fidelity of the theory-based Health Empowerment Intervention (HEI) was assessed and maintained in a sample of older homebound adults, using criteria outlined by Bellg and colleagues (2004). Evaluation of Intervention Fidelity: Fifty-nine older adults participanted in the RCT (32 intervention; 27 attention comparison). Human subjects approval was obtained prior to the study. A master’s prepared nurse interventionist (NI) delivered the manualized HEI, which included weekly individualized sessions over 6 weeks. Fidelity in study design included a strong and identifiable integration of theory within the HEI, targeting mediating processes and outcomes. HEI delivery was based on a standardized manual and protocol for implementation. Training of the NI was over two-weeks, focusing on the Health Empowerment Theory, delivery of the standardized HEI, including role play with case examples, monitoring fidelity of HEI delivery, and managing issues around home delivery of the HEI, including  malnutrition,  illness, or adult abuse. NI training and monitoring of HEI manualized protocol were conducted by the principal investigator throughout the study. The HEI critical inputs were designed with clear specification in content and activities, allowing contrast with the attention comparison condition. Process evaluation was conducted following each HEI session to quantify the dose delivered to participants and identify strengths and limitations in delivery. HEI sessions were randomly audio taped to compare content delivered with that specified in the HEI manual using an Index of Procedural Consistency, with regular performance feedback to NI, as well as a log of each session, including the duration and content of contacts with participants. Evaluation of HEI receipt included review of individual goal setting, documentation of actions taken to attain goals, and identification of personal and social resources. Enactment of the HEI was evaluated self-report of goal achievement, and actions fostering purposeful participation in change. Conclusions: Content fidelity of the HEI was assessed beginning with the initial sessions and continued throughout the entire study. Overall, the NI successfully delivered the theory-based intervention as outlined in the Health Empowerment manual. Assessing fidelity of an intervention was key to attributing change in the  participants receiving HEI. The HEI enhanced health empowerment in homebound older adults, thereby, promoting the attainment of individualized health goals.   
Keywords:
Health Empowerment Intervention; Intervention fidelity
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5415
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleASSESSING THE FIDELITY OF THE HEALTH EMPOWERMENT INTERVENTIONen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211543-
dc.description.abstractIntervention fidelity in a randomized controlled trial (RCT) reflects  the degree to which an interventionist adheres to the protocal specific to the treatment. However, assessment of treatment fidelity is often overlooked when conducting a RCT, limiting the ability to rule out alternative explainations for intervention effects. Aims: The purpose of this paper is to describe  how fidelity of the theory-based Health Empowerment Intervention (HEI) was assessed and maintained in a sample of older homebound adults, using criteria outlined by Bellg and colleagues (2004). Evaluation of Intervention Fidelity: Fifty-nine older adults participanted in the RCT (32 intervention; 27 attention comparison). Human subjects approval was obtained prior to the study. A master’s prepared nurse interventionist (NI) delivered the manualized HEI, which included weekly individualized sessions over 6 weeks. Fidelity in study design included a strong and identifiable integration of theory within the HEI, targeting mediating processes and outcomes. HEI delivery was based on a standardized manual and protocol for implementation. Training of the NI was over two-weeks, focusing on the Health Empowerment Theory, delivery of the standardized HEI, including role play with case examples, monitoring fidelity of HEI delivery, and managing issues around home delivery of the HEI, including  malnutrition,  illness, or adult abuse. NI training and monitoring of HEI manualized protocol were conducted by the principal investigator throughout the study. The HEI critical inputs were designed with clear specification in content and activities, allowing contrast with the attention comparison condition. Process evaluation was conducted following each HEI session to quantify the dose delivered to participants and identify strengths and limitations in delivery. HEI sessions were randomly audio taped to compare content delivered with that specified in the HEI manual using an Index of Procedural Consistency, with regular performance feedback to NI, as well as a log of each session, including the duration and content of contacts with participants. Evaluation of HEI receipt included review of individual goal setting, documentation of actions taken to attain goals, and identification of personal and social resources. Enactment of the HEI was evaluated self-report of goal achievement, and actions fostering purposeful participation in change. Conclusions: Content fidelity of the HEI was assessed beginning with the initial sessions and continued throughout the entire study. Overall, the NI successfully delivered the theory-based intervention as outlined in the Health Empowerment manual. Assessing fidelity of an intervention was key to attributing change in the  participants receiving HEI. The HEI enhanced health empowerment in homebound older adults, thereby, promoting the attainment of individualized health goals.   en_GB
dc.subjectHealth Empowerment Interventionen_GB
dc.subjectIntervention fidelityen_GB
dc.date.available2012-02-20T12:01:20Z-
dc.date.issued2012-02-20T12:01:20Z-
dc.date.accessioned2012-02-20T12:01:20Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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