Souraya Sidani - Nursing and Health Interventions

The terms “intervention,” “treatment,” and “therapy” are interchangeable. Although widely used in written (e.g. books, published research reports) and verbal (e.g. case conference, end of shift report in the practice setting) communications, only a few formal definitions of interventions have been located in recent literature ( Table 2.1). A thorough examination of these definitions points to two key attributes that define interventions. The first attribute is that interventions are essentially activities. They involve the application of specific techniques by the health professional delivering interventions and the clients receiving interventions. The second attribute is rationality. Rationality means that interventions are given in response to an actual or potential health problem, and directed toward attainment of desired goals. Accordingly, interventions are sets of activities performed by health professionals and clients, independently or collaboratively, to address problems experienced by clients and to achieve beneficial outcomes.

Interventions are more specific than strategies. Strategies provide general principles informing the generation of new or the selection of available evidence‐based techniques. For instance, a behavioral conceptualization of chronic insomnia provided guidance for developing the stimulus control therapy. The stimulus control therapy consists of specific recommendations for sleep behaviors (known to perpetuate insomnia) to do or avoid, and specific techniques to assist clients in carrying out these recommendations. The techniques include providing information on the association between sleep behaviors and insomnia, prompting identification of barriers and possible solutions, and encouraging self‐monitoring of sleep behaviors and parameters. These three specific techniques are described as replicable behavior change techniques designed to alter behaviors (Abraham & Michie, 2008; Carey et al., 2018).

TABLE 2.1 Formal definitions of interventions.

Programs, complex interventions, and multicomponent interventions consist of multiple interventions that have been grouped into a package. The package is often designed to address: (1) a health problem that is conceptualized from different perspectives and experienced in different domains of health (e.g. cognitive and behavioral, as is the case with chronic insomnia); (2) a health problem that is attributable to a range of determinants occurring in different domains of health (e.g. physical, psychological, social) and at different levels (e.g. individual, community, healthcare system); or (3) co‐occurring and inter‐related health problems (e.g. comorbidity or multi‐morbidity that is, the presence of multiple acute and chronic conditions among older adults). Examples of programs are provided in Table 2.2.

Interventions are described in terms of the goals they are set to achieve and the components comprising them.

Interventions are designed to attain one or more goals related to a particular health problem. An intervention goal is a statement of what exactly the intervention is expected to achieve relative to the health problem it targets. Some interventions aim to modify the determinants or causes of the health problem and, hence, to prevent its occurrence. For example, changing a nonambulatory client's position in bed every two hours aims to prevent pressure ulcer, and instructing clients with asthma to avoid irritants such as dust and smoke is directed at preventing dyspnea. Other interventions are designed to manage the health problem, to reduce its burden, and/or to mitigate its negative consequences. For instance, taking a medication is useful in self‐managing muscle pain whereas listening to music is helpful in reducing the emotional reactions to pain such as anxiety (i.e. its burden); both interventions relieve pain and minimize its contribution to limited physical functioning (i.e. its negative consequences). Other interventions are directed at promoting engagement in health‐related behaviors such as physical activity and smoking cessation and consequently, enhancing general health and well‐being.

Interventions are comprised of one or more components. A component is a set of activities or techniques that are directed toward addressing a common goal. For example, the multicomponent intervention for insomnia described in Table 2.2consists of four components, each addressing one goal: (1) sleep education and hygiene aims to help clients understand the factors that perpetuate insomnia, and the general behavioral and environmental recommendations to promote a good night's sleep; (2) stimulus control therapy focuses on reassociating the bed with sleep; (3) sleep restriction therapy aims to consolidate sleep; and (4) behavior change support is set to facilitate clients' initiation, engagement, and adherence to all treatment recommendations in their daily life context.

TABLE 2.2 Examples of programs or multicomponent interventions.

There are two categories of intervention components: specific and nonspecific. Specific components are unique and essential in distinguishing the intervention. They represent the “active ingredients,” which are theoretically hypothesized to bring about the intended changes in the health problem and to produce related beneficial outcomes (Carey et al., 2018; Kühne et al., 2015; Michie et al., 2009). The nonspecific components are techniques used to enable, support, reinforce, or facilitate the implementation of the intervention's specific components (Sidani et al., 2020). Nonspecific components are usually not unique to a particular intervention and, therefore, are not expected to contribute significantly to the intended beneficial outcomes (Araújo‐Soares et al., 2018). Recent evidence, however, suggests that nonspecific components, in combination with the way the intervention is delivered, may enhance or undermine its effectiveness (Dombrowski et al., 2016). For example, sleep education and hygiene, stimulus control therapy and sleep restriction therapy are specific components of the multicomponent intervention for insomnia. The behavior change support is a nonspecific component because it is generic and can be integrated in other health behavior change interventions.