Assessing the Strength and Integrity of an Intervention

Patricia A. Brandt

Sallie Davis Kirsch

Frances Marcus Lewis

Susan M. Casey

ONF 2004, 31(4), 833-837. DOI: 10.1188/04.ONF.833-837

Purpose/Objectives: To evaluate the strength and integrity of a pilot behavioral intervention designed to assist mothers with breast cancer and their children.

Research Approach: A single-group analysis of the strength and integrity characteristics of an intervention developed for a pilot research study.

Setting: Homes of study participants in an urban area.

Participants: Seven households with a mother and father and one household with a single mother.

Methodologic Approach: Observer-reported checklists, audiorecorded intervention session data, and structured interview data obtained from study participants.

Main Research Variables: Strength of the intervention included dimensions such as the theoretical foundation, competence of the interventionist, and specificity to the breast cancer experience in the family. Intervention integrity consisted of adherence by the interventionist and participants to the intervention plan.

Findings: The strength of the intervention was determined to be an asset. Careful planning had included a framework, a defined set of scripted sessions, a competent interventionist, and content specific to the breast cancer experience. In regard to integrity, the protocol content was delivered as scripted. Improvements in the dosage and purity dimensions were found to be needed. Homework assignments and in-session skill-building approaches with the mothers were refined.

Conclusions: An intervention can be examined carefully for strength and integrity with established criteria to determine improvements needed.

Interpretation: A clinical research protocol can be improved through an assessment of an intervention's strength and integrity.

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    References

    Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.

    Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman.

    Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, 1-26.

    Conn, V.S., Rantz, M.J., Wipke-Tevis, D.D., & Maas, M.L. (2001). Designing effective nursing interventions. Research in Nursing and Health, 24, 433-442.

    Costner, H. (1989). The validity of conclusions in evaluation research: A further development of Chen and Rossi's theory-driven approach. Evaluation and Program Planning, 12, 345-353.

    Dishion, T.J., McCord, J., & Poulin, F. (1999). When interventions harm. Peer groups and problem behavior. American Psychologist, 54, 755-764.

    Hartley, D. (1985). Research on the therapeutic alliance in psychotherapy. In R.E. Hales & A.J. Frances (Eds.)Psychiatry update: American Psychiatric Association Annual Review (vol. 4, pp. 532-549). Washington, DC: American Psychiatric Association Press.

    Horvath, A.O., & Greenberg, L.S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223-233.

    Horvath, A.O., & Symonds, B.D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38, 139-149.

    Kirsch, S.E.D., Brandt, P.A., & Lewis, F.M. (2003). Making the most of the moment: When a child's mother has breast cancer. Cancer Nursing, 26, 47-54.

    Lewis, F.M. (1996). Final report: The family visitation study (RO1-CA-55347). Seattle, WA: University of Washington.

    Lewis, F.M., Casey, S., Brandt, P., Shands, M., & Zahlis, E. (2004). The enhancing connections program: A pilot study for mothers and children experiencing maternal breast cancer. Manuscript submitted for publication.

    Lincoln, Y.S., & Guba, E.G. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.

    Marmar, C., Weiss, D., & Gaston, L. (1989). Toward the validation of the California Therapeutic Alliance Rating System. Journal of Consulting and Clinical Psychology, 1, 46-52.

    Munro, B.H. (1997). Statistical methods for healthcare research. Philadelphia: Lippincott.

    National Institutes of Health. (2001). Further guidance on a data and safety monitoring for phase I and phase II trials. Retrieved July 1, 2003, from http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-038.html

    Scott, A.G., & Sechrest, L. (1989). Strength of theory and theory of strength. Evaluation and Program Planning, 12, 329-336.

    Shands, M.E., Lewis, F.M., & Zahlis, E.H. (2000). Mother and child interactions about the mother's breast cancer: An interview study. Oncology Nursing Forum, 27, 77-85.

    Siegel, S., & Castellan, N.J., Jr. (1990). Nonparametric statistics for the behavioral sciences (2nd ed.). New York: McGraw-Hill.

    Smith, B., & Sechrest, L. (1998). Treatment of aptitude x treatment interactions. In A.E. Kazdin (Ed.)Methodological issues and strategies in clinical research (2nd ed., pp. 495-520). Washington, DC: American Psychologic Association.

    Strauss, A.L., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Thousand Oaks, CA: Sage.

    Tracey, T.J., & Kokotovic, A.M. (1989). Factor structure of the Working Alliance Inventory. Psychologic Assessment, 1, 207-210.

    Waltz, J., Addis, M.E., Koerner, K., & Jacobson, N.S. (1993). Testing the integrity of a psychotherapy protocol: Assessment of adherence and competence. Journal of Consulting and Clinical Psychology, 61, 620-630.

    Yeaton, W., & Sechrest, L. (1992). Critical dimensions in the choice and maintenance of successful treatments: Strength, integrity and effectiveness. In A.E. Kazdin (Ed.)Methodological issues and strategies in clinical research (pp. 137-156). Washington, DC: American Psychologic Association.

    Yeaton, W.H. (1994). The development and assessment of valid measures of service delivery to enhance inference in outcome-based research: Measuring attendance at self-help group meetings. Journal of Consulting and Clinical Psychology, 62, 686-694.

    Zahlis, E.H. (2001). The child's worries about the mother's breast cancer: Sources of distress in school-age children. Oncology Nursing Forum, 28, 1019-1025.

    Zahlis, E.H., & Lewis, F.M. (1998). Mothers' stories of the school-age child's experience with the mother's breast cancer. Journal of Psychosocial Oncology, 16(2), 25-43.