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Table 1 Overview of the step-by-step process of Intervention Mapping with methods used and results produced at each step

From: Systematic development of CHEMO-SUPPORT, a nursing intervention to support adult patients with cancer in dealing with chemotherapy-related symptoms at home

 

Methods

Results

Step 1

Needs assessment:

Objectives: establishing participatory planning groups, conducting the needs assessment, specifying desired programme goals

♦ Literature review of symptom self-management in patients with cancer

♦ Qualitative study on dealing with chemotherapy-related symptoms at home [3]

♦ One discussion session with professional panel and one with patients and caregivers panel

♦ Needs structured in PRECEDE-model (Fig. 1)

♦ Reported and observed behavioral problems: patients’ poor/inadequate self-management, poor communication and reporting of chemotherapy-related symptoms

♦ Desired program goals: improving self-management and communication/reporting of chemotherapy-related symptoms

Step 2

Matrices of proximal programme objectives

Objectives: stating behavioral and environmental outcomes of the intervention, defining clear performance objectives (POs), creating matrices of change objectives by crossing POs with determinants

♦ Outline of matrices of proximal programme objectives by project leader

♦ Review of theory and outline of potential determinants

♦ One discussion session with professional panel and two discussion sessions with patients and caregivers panel

♦ Consensus on four patient performance objectives (POs):

 Preventing, monitoring, reporting and managing chemotherapy-related symptoms at home

♦ Consensus reached on vital determinants:

 Self-efficacy and outcome expectations of patients

♦ Matrices of proximal programme objectives for future program receivers (patients) (example in Table 2)

♦ Definition of nursing objectives to support patients’ performance objectives

Step 3

Selecting theoretical methods and practical strategies

Objectives: generating programme ideas, identifying and selecting theoretical methods, selecting or designing practical applications

♦ Study of methods and theories [16, 18, 19]

♦ Evaluation of the ideas on methods and strategies yielded in the earlier panel meetings

♦ Systematic review of complex nursing interventions aimed at reducing chemotherapy-related symptom burden [10]

♦ One discussion session with professional panel and one with patients and caregivers panel

♦ One discussion session with nursing panel

♦ Consensus on principal methods of the intervention: tailoring and motivational interviewing

♦ General outline of the intervention (Fig. 2): Brief motivational intervention, advanced on the basis of estimated individual need

♦ Formulation of additional project objective for the purpose of the intervention: revision of written patient information and advices

Step 4

Producing programme components

Objectives: determining preferences for programme design, creating programme scope and sequence, preparing design, reviewing, developing and pretesting programme materials

Intervention manual development:

♦ Formulating nursing approach at every patient contact in the program

♦ Discussion with project team, nursing panel, 2 onco-psychologists

Final intervention manual produced

New written patient information development:

♦ Web survey eliciting patient feedback (n = 102, characteristics see Table 3) on information and advice for 19 chemotherapy-related symptoms (question format see Table 1)

♦ First revision and second patient feedback round (n = 21)

♦ Feedback and discussion with healthcare professionals (n = 17)

New booklet produced “Dealing with side effects from chemotherapy at home”, outlining the 4 recommended self-management behaviours and presenting information and (professional and fellow patient) advice on 19 side effects

Step 5

Planning for adoption, implementation and sustainability

Objectives: identifying potential adopters, stating outcomes for programme use, specifying determinants and creating matrices (defining determinants and change objectives) for programme adoption, implementation and sustainability

Planning for the implementation of the intervention in an intervention study:

♦ Planning selection strategy and criteria for the intervention providers in the study

♦ Translating nurse POs into training programme for the intervention nurses

♦ Outlining communication strategy for clinical nurses and other healthcare professionals

♦ Selection of 6 intervention nurses

♦ 2-day long training programme for the intervention nurses

♦ Meetings (n = 9) with clinical nurses (n = 114)

♦ Meetings with doctors and paramedics

Step 6

Planning for intervention evaluation

Objectives: describing programme outcomes, writing evaluation questions, developing indicators and measues, specifying evaluation design

Together with the project team:

♦ Translating health and quality of life targets, POs and determinants into study outcomes

♦ Choosing appropriate methods and study design

♦ Protocol of a mixed-methods study

♦ Qualitative approach to explore patient experience with the intervention: satisfaction with intervention, open questions and semi-structured interviews

♦ Quantitative approach to study intervention effect: experimental before-after study with sequential design

 Primary outcome: Symptom distress

 Secondary outcomes:

 Symptom severity

 Self-efficacy

 Outcome expectations

 Self-care