You might have heard the term “intervention” quite a lot – on TV (if you know How I Met Your Mother, you know what we mean!) or maybe you’ve read it in a blog or academic paper. In research, interventions are important. They enable researchers to address a problem and figuring out how to help people by, for example, creating programs that aim to alleviate challenges individuals might encounter.
In order to be perceived as good or worthwhile, an intervention should be effective, meaningful but also replicable. For many years, it has been common that researchers determined the content, execution and evaluation of interventions without consulting the intervention’s target group. Hence, research was rather done on people rather than with them. However, in recent years, researchers started to view interventions’ target populations (like patients having in-depth knowledge of mental health centres) as valuable informers. Involving these individuals in deciding what should be done and how, made interventions not only more effective but also more meaningful. Consequently, researchers increasingly involve individuals from target groups in in co-producing and developing their interventions - often with great success. Check out the SPRINT Project’s MST4life project here for an example.
While interventions have grown more effective and meaningful, they can remain difficult to replicate. Partly, this can be due researchers struggling to report the steps and characteristics implemented to develop an intervention. So, what could help researchers to document their intervention building process, while guiding them to incorporate crucial steps in their intervention development? Enter: intervention frameworks. These can be seen as step-by-step approaches, recipes, or idea banks that researcher can consult or follow when starting to plan and design an intervention. Maybe unsurprisingly, the popularity of intervention frameworks has increased in recent years, and, as a result, there are several approaches that researchers can chose from. Not all intervention frameworks are the same and often differ in how they involve individuals from target populations, what kind of methods they prefer to be used and what stages of intervention building they cover.
One of them is the person-based approach (PBA), an intervention framework that uses qualitative and mixed methods to ensure, that the process of intervention development considers the beliefs, attitudes, needs and context of the particular user group the intervention is designed to target (Ferrey et al., 2018). These insights are used to inform, design, adapt and optimise the intervention to ensure that all intervention components are meaningful, feasible and engages all users (Morrison et al., 2018; Muller et al., 2019). As shown in figure 1, PBA is an iterative, systematic intervention development framework that can be divided into three stages: intervention planning, intervention design and intervention development and evaluation of acceptability and feasibility (Yardley, Ainsworth, et al., 2015; Yardley, Morrison, et al., 2015).
Image description: A diagram showing the person-based approach model (Morrison et al., 2018).
As Michelle’s PhD is dedicated to developing a mental skills training program for a hard to reach group of dancers (and thus involves building an intervention), this framework immediately caught her interest. Would this enable her to involve the dancers and other crucial dance professionals in designing the intervention? And how would she proceed in planning, designing and eventually testing the intervention for its feasibility? As the University of Bristol in association with the National Institute for Health and Care Research (NIHR) organized a person-based approach workshop, Michelle seized the opportunity and partook in an online based session last week.
The person-based approach online workshop
Some days prior to the workshop, the facilitating team sent out materials that would be used in the session. These materials indicated that participants would be actively involved in the workshop and Michelle got excited to be learning about the different intervention stages in a practical manner. Finally, the day was here and the 3,5 hour workshop was about to begin. After everybody logged onto Teams, the facilitators introduced the framework and its different stages.
The first stage of the intervention (intervention planning) introduced the workshop participants to the idea of forming advisory groups consisting of people representing the targeted group for the intervention and other experts with valuable insights into the target population or the challenges to be tackled in the research. Researchers actively engage with this advisory group in different ways (workshops, meetings) and also involve these informants in qualitative research throughout the intervention planning stage. Insights gained from qualitative investigations are eventually used to formulate guiding principles. These will underpin the intervention and specify (1) what the intervention must do to address the needs of the target user and (2) key intervention features that will support achievement of the design objectives (e.g., behaviour change techniques, broader aspects of intervention delivery) (Yardley, Morrison, et al., 2015). To become more familiar with these principles and how they should be formulated, the workshop facilitators presented different intervention features to the participants. These were then discussed in break out rooms and tweaked to make them more feasible and understandable.
After a short break, the workshop moved onto discussing aspects of the second phase of the intervention: the intervention development. In this particular phase of PBA, the guiding principles we encountered in the first part of the workshop are used to inform the development of an intervention prototype and supporting materials (e.g., websites, booklets, guides, leaflets). However, the facilitators not only introduced us to the idea of creating these materials, but also to use think-aloud interviews to test them on our target users. While Michelle has been trained in different interview techniques, this kind of qualitative approach was rather new to her. There was no time to be bashful though, as the facilitators, again, put the workshop participants into break out rooms to rehearse these think-aloud interviews with each other. Michelle was fascinated how hearing other participants’ thoughts on the presented material could be immensely helpful in determining whether an intervention prototype might be persuasive, easy to use and feasible (Morrison et al., 2018; Yardley, Morrison, et al., 2015). While researchers might need some further training to effectively engage with this interview approach, this method ensures that target users’ feedback is heard and that their suggested changes can easily be incorporated.
How to implement these suggested changes became the main focus In the next activity. First, the facilitators discussed how the results of these interviews could be coded into negative, positive or neutral comments and presented in a table they fittingly called “the table of change”. Then, participants were asked to pretend to be an advisory group and discuss the content of a mock table of change and code the necessity or urgency of different, suggested adjustments. Hence, this activity prepared the workshop participants to the intricacies of eventually presenting and discussing a table of change with their own advisory group and facilitate constructive discussion that will determine, which suggested modifications are necessary to implement and which changes can be bypassed. As this very insightful activity has shown, researchers can benefit from seeking their advisory group’s advice, thus letting their insights actively influence the intervention development process.
Finally, the workshop moved onto the last part of the session, in which the now improved intervention is being tested for its feasibility and acceptability. For that purpose, the facilitators presented and discussed different mixed methods approaches that can be used to understand people’s experiences of the final intervention prototype (Morrison et al., 2018; Muller et al., 2019). For example, qualitative evidence could explore potential barriers to intervention success or implementation and provide insight into user’s experiences of engaging in behaviour change (Morrison et al., 2018). This evidence can be triangulated with quantitative intervention data to enhance the understanding of how people engage with the intervention, where the intervention might be working well and how it would need adjusting prior to implementation (Morrison et al., 2018; Muller et al., 2019). The workshop was then concluded with a Q&A session.
Logging out of Teams after these eventful 3.5 hours, Michelle was left inspired and elated. PBA is an approach that is strikingly flexible while providing enough guidance to tailor-make interventions for hard to reach target groups. Yet, PBA might be time consuming and Michelle had to acknowledge that it would be easy to get “stuck” in an intervention step, especially if one would feel the need to elicit a lot of user feedback to improve intervention materials/ prototypes. Nevertheless, considering that there are few existing mental skills intervention in dance and we generally have little insight into dancers’ experience with mental skills training, Michelle liked the idea of using qualitative research in most of the intervention steps. Hence, PBA might represent a good framework to create solid building blocks for psychological interventions, especially if they are targeting hard to reach populations like dancers.
No intervention framework will – as research in general – ever be perfect. But as the PBA workshop has proven, they can be helpful tools in not only making interventions replicable but also engaging, effective and meaningful.
References
Ferrey, A. E., Sivyer, K., Greenwell, K., & Corbett, T. (2018). The person-based approach in practice: Methods for intervention development. Qualitative Methods in Psychology Bulletin (26).
Morrison, L., Muller, I., Yardley, L., & Bradbury, K. (2018). The person-based approach to planning, optimising, evaluating and implementing behavioural health interventions. The European Health Psychologist, 20(3), 464-469.
Muller, I., Santer, M., Morrison, L., Morton, K., Roberts, A., Rice, C., Williams, M., & Yardley, L. (2019). Combining qualitative research with PPI: reflections on using the person-based approach for developing behavioural interventions. Research involvement and engagement, 5(1), 1-8.
Yardley, L., Ainsworth, B., Arden-Close, E., & Muller, I. (2015). The person-based approach to enhancing the acceptability and feasibility of interventions. Pilot and feasibility studies, 1(1), 1-7.
Yardley, L., Morrison, L., Bradbury, K., & Muller, I. (2015). The person-based approach to intervention development: application to digital health-related behavior change interventions. Journal of medical Internet research, 17(1), e4055.
Photo credit: Morrison et al., (2018).
Written by Michelle Schachtler Dwarika, PhD Researcher in the SPRINT Project.