Showing papers by "Souraya Sidani published in 2015"

Attrition in Smoking Cessation Intervention Studies: A Systematic Review.

Abstract: Withdrawal of participants from intervention studies has dire methodological and clinical consequences. Attrition rates in smoking cessation studies have been found to be particularly high. Identifying factors that contribute to attrition may inform strategies to address the problem and prevent its consequences. This systematic review had 2 objectives: to report attrition rates, and to identify factors that influence attrition of adult smokers participating in smoking cessation intervention studies. Inclusion criteria were (1) published between 1980 and 2015; (2) experimental or quasi-experimental design; (3) pharmacological, educational, or behavioural intervention; (4) target population of adult smokers; (5) examination of attrition rate; and (6) exploration of factors associated with attrition and/or of reasons given by participants for withdrawing. These criteria were met by 10 studies. Attrition rates ranged from 10.8% to 77%. A small number of demographic, clinical, behavioural, health, health-related beliefs, and logistical factors were related to attrition. The report of high attrition rates underlines the importance of incorporating strategies to minimize attrition in smoking cessation studies. Strategies to reduce attrition are proposed.

Fidelity of Intervention Implementation: A Review of Instruments

Abstract: Background: Interventions, whether simple or complex, are increasing in health care in response to the growing complexity and acuity of patient’s conditions. Monitoring the fidelity of implementing interventions is challenging. A common method to assess and monitor fidelity of intervention implementation is through a structured, reliable and valid instrument. Purpose: The purpose of this paper is to examine existing instruments measuring fidelity of intervention implementation in order to determine aspects of fidelity that have been assessed and reported on the reliability and validity of these instruments. Design: A descriptive review was conducted. Studies were included if they described and reported on the fidelity of intervention implementation instruments, their psychometric properties were published between 1980 and 2015. Methods: Data were extracted on the study characteristics, levels and aspects of fidelity and the psychometric properties, specifically the reliability and validity of the fidelity of intervention implementation instruments. Results: In total, 21 studies were included in the review. Overall results showed that some aspects and levels of fidelity of intervention implementation are included in the instruments. At the theoretical level, fidelity of intervention implementation is not accounted for majority of the studies and few explicitly reports on the use of instruments to evaluate intervention differentiation. At the operational level, interventionists’ adherence and competence are included in the instruments; however, participants’ engagement, exposure and enactment are not. The instruments demonstrate acceptable level of validity and reliability. Conclusion: Sustained focus on developing psychometrically sound instruments that account for all levels (i.e. theoretical and operational) and aspects of fidelity of intervention implementation is imperative to strengthen the methodological literature for interventions research; and for researchers to correctly interpret research findings and to arrive at valid conclusions on the effectiveness of interventions, whether simple or complex.

Nurse practitioner interactions in acute and long-term care: an exploration of the role of knotworking in supporting interprofessional collaboration

Abstract: Interprofessional care ensures high quality healthcare. Effective interprofessional collaboration is required to enable interprofessional care, although within the acute care hospital setting interprofessional collaboration is considered suboptimal. The integration of nurse practitioner roles into the acute and long-term care settings is influencing enhanced care. What remains unknown is how the nurse practitioner role enacts interprofessional collaboration or enables interprofessional care to promote high quality care. The study aim was to understand how nurse practitioners employed in acute and long-term care settings enable interprofessional collaboration and care. Nurse practitioner interactions with other healthcare professionals were observed throughout the work day. These interactions were explored within the context of “knotworking” to create an understanding of their social practices and processes supporting interprofessional collaboration. Healthcare professionals who worked with nurse practitioners were invited to share their perceptions of valued role attributes and impacts. Twenty-four nurse practitioners employed at six hospitals participated. 384 hours of observation provided 1,284 observed interactions for analysis. Two types of observed interactions are comparable to knotworking. Rapid interactions resemble the traditional knotworking described in earlier studies, while brief interactions are a new form of knotworking with enhanced qualities that more consistently result in interprofessional care. Nurse practitioners were the most common initiators of brief interactions. Brief interactions reveal new qualities of knotworking with more consistent interprofessional care results. A general process used by nurse practitioners, where they practice a combination of both traditional (rapid) knotworking and brief knotworking to enable interprofessional care within acute and long-term care settings, is revealed.

Examining the influence of treatment preferences on attrition, adherence and outcomes: a protocol for a two-stage partially randomized trial.

Abstract: Background Empirical evidence pertaining to the influence of treatment preferences on attrition, adherence and outcomes in intervention evaluation trials is inconsistent. The inconsistency can be explained by the method used for allocating treatment and measuring preferences. The current methodological study is designed to address these factors by implementing the two-stage partially randomized or preference trial design, and administering a validated measure to assess participants’ preferences for the treatments under evaluation. It aims to compare attrition, adherence and outcomes for participants allocated randomly or by preference to treatment. The study is in its final stages of data collection; its protocol is presented in this paper.

The Contribution of Treatment Allocation Method to Outcomes in Intervention Research.

Abstract: The purpose of this methodological study was to examine the contribution of treatment allocation method (random vs. preference) on the immediate, intermediate, and ultimate outcomes of a behavioural intervention (MCI) for insomnia. Participants were allocated to the MCI randomly or by preference. Outcomes were assessed before, during, and after completion of the MCI using validated self-report measures. Analysis of covariance was used to compare the post-test outcomes for the 2 groups, controlling for baseline differences. Compared to those randomized, participants in the preference group showed improvement in most immediate outcomes (sleep onset latency, wake after sleep onset, sleep efficiency), both intermediate outcomes (insomnia severity and daytime fatigue), and one ultimate outcome (resolution of insomnia). Using a systematic method for eliciting participants' preferences and involving participants in treatment selection had a beneficial impact on immediate and intermediate outcomes. Additional research should validate the mechanism through which treatment preferences contribute to outcomes.

Discourse / Discours - The Contribution of Treatment Allocation Method to Outcomes in Intervention Research

Abstract: The purpose of this methodological study was to examine the contribution of treatment allocation method (random vs. preference) on the immediate, intermediate, and ultimate outcomes of a behavioural intervention (MCI) for insomnia. Participants were allocated to the MCI randomly or by preference. Outcomes were assessed before, during, and after completion of the MCI using validated self-report measures. Analysis of covariance was used to compare the post-test outcomes for the 2 groups, controlling for baseline differences. Compared to those randomized, participants in the preference group showed improvement in most immediate outcomes (sleep onset latency, wake after sleep onset, sleep efficiency), both intermediate outcomes (insomnia severity and daytime fatigue), and one ultimate outcome (resolution of insomnia). Using a systematic method for eliciting participants' preferences and involving participants in treatment selection had a beneficial impact on immediate and intermediate outcomes. Additional research should validate the mechanism through which treatment preferences contribute to outcomes.

Effects of a Multi-Component Behavioral Intervention (MCI) for Insomnia on Depressive and Insomnia Symptoms in Individuals with High and Low Depression

Abstract: Insomnia and depression are prevalent and co-occurring conditions that are associated with significant impairment of life. Previous research indicates that cognitive-behavioral interventions for insomnia (CBT-I) can improve both insomnia and depressive symptoms. The aim of the authors in this study was to determine whether a multi-component behavioral intervention (MCI) improved both insomnia and depressive symptoms in persons presenting with insomnia and high levels of depression. The sample consisted of 321 individuals with insomnia who participated in a trial of insomnia treatments; 106 participants had high levels of depression (score ≥ 16 on CES-D) at baseline. Participants either received the MCI or a control treatment (sleep education and hygiene booklet). At post-test, participants with high and low levels of depressive symptoms showed significant improvement in insomnia symptoms. Those with high depression also had significant reductions in depressive symptoms. It can be concluded that for indivi...

A description of nurse practitioners' self-report implementation of patient-centered care

Abstract: This study aimed to describe the nurse practitioners’ self-reported implementation of patient-centered care (PCC) and factors that influence their delivery of PCC. It was guided by a conceptualization of PCC that identified three components that distinguish PCC (i.e. holistic, collaborative, and responsive care) and respective activities that operationalize them. A sample of 149 nurse practitioners employed in acute and long term care settings, in Ontario Canada, completed a valid and reliable measure of the extent to which they implemented the three PCC components. The results indicated that the majority of respondents reported engagement in most activities reflective of the PCC components, most of the time, and that experienced nurse practitioners performed a large number of these activities. Further research should examine the contribution of each PCC component, as implemented by nurse practitioners and other members of the healthcare team, to patient-oriented outcomes.

Discourse / Discours - Method of Treatment Allocation: Does It Affect Adherence to Behavioural Therapy for Insomnia?

Abstract: Adherence to treatment is critical in determining the effects of behavioural therapy and may be affected by participants' preference for treatment. The purpose of this study was to determine the extent to which method of allocation to treatment (random vs. preference-based) influences adherence (exposure and enactment) to behavioural therapy. Participants received behavioural therapy for the management of insomnia randomly or by preference. Exposure was assessed as attendance at the treatment sessions, enactment as self-reported application of treatment recommendations. Participants (N = 262) attended a mean of 5.6 treatment sessions, applied the treatment recommendations frequently, and reported high levels of overall compliance. There was no difference between the random and preference groups in terms of exposure to and enactment of treatment. Randomization to the preferred treatment, dissatisfaction with the allocated treatment, and self-report bias could play a role in the findings and should be explored in future research.

Discourse / Discours - Attrition in Randomized and Preference Trials of Behavioural Treatments for Insomnia

Abstract: Preferences for treatment contribute to attrition. Providing participants with their preferred treatment, as done in a partially randomized clinical or preference trial (PRCT), is a means to mitigate the influence of treatment preferences on attrition. This study examined attrition in an RCT and a PRCT. Persons with insomnia were randomly assigned (n = 150) or allocated (n = 198) to the preferred treatment. The number of dropouts at different time points in the study arms was documented and the influence of participant characteristics and treatment-related factors on attrition was examined. The overall attrition rate was higher in the RCT arm (46%) than in the PRCT arm (33%). In both arms, differences in sociodemographic and clinical characteristics were found between dropouts and completers. The type of treatment significantly predicted attrition (all p ≤ .05). The results provide some evidence of a lower attrition rate in the PRCT arm, supporting the benefit of accounting for preferences as a method of treatment allocation.