Abstract
Background: Although an assumption of consistency in intervention delivery is key to the conclusion that the findings are valid, attention to both interventionist adherence and competence has not become a standard in nursing intervention research.
Objectives: The purpose of this article is to describe the technology model of intervention fidelity as it applies to psychosocial interventions, and to propose its application in nursing intervention research as a way to support accurate conclusions about validity.
Methods: The features and methods of the Technology Model of intervention fidelity were reviewed. The review included development of a manual, training and supervision of interventionists, measurement of intervention fidelity, and inclusion of intervention fidelity as an independent variable in the analysis.
Results: The Technology Model and the associated methodologies that have been used to monitor psychosocial intervention fidelity in psychiatry can be adapted and applied by nursing. Monitoring costs can be managed through use of a general system that can be applied across programmatic or related studies.
Conclusions: Application of the Technology Model of intervention fidelity could advance the maturation of nursing intervention research and evidence-based clinical practice.
Intervention fidelity, defined as the adherent and competent delivery of an intervention by the interventionist as set forth in the research plan, is fundamental to the inference of validity in nursing intervention research. The nursing literature on intervention fidelity has included adherence, defined it as the degree to which the prescribed elements of an intervention have been delivered and proscribed elements avoided (Waltz, Addis, Koerner, & Jacobson, 1993). The attention on the interventionist's behavior distinguishes the meaning of adherence as it is used in this report from the meaning of adherence associated with whether the client carried out the prescribed activities or not. Competence is defined as the extent to which the interventionist has displayed behaviors that typically engage participants in the intervention and affect outcomes in the desired direction (Najavits & Weiss, 1994).
Because an interventionist's ability to engage participants can affect whether offered interventions are used and have adequate opportunities to produce change, both adherence and competence assessments are necessary for an inference of validity. The focus of this presentation is on psychosocial interventions. These interventions are highly flexible, individualized and not easily articulated, and difficult to judge for validity.