Finch Tracy L, Bamford Claire, Deary Vincent, Sabin Neil, Parry Steve W
Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne NE2 4AX, UK.
BMC Health Serv Res. 2014 Sep 25;14:436. doi: 10.1186/1472-6963-14-436.
Fear of Falling (FoF) is commonly reported among older adults (up to 50%) and can impact negatively on physical and social activities, mood and quality of life. This paper explores the development, acceptability and feasibility of a cognitive behavioural therapy intervention (CBTi) for FoF.
The process evaluation of the CBTi development phase of an RCT (conducted in the UK) reported here, used ethnographic methods. Data included: interviews with patients and carers (n = 16), clinic staff (n = 6) and the psychologists developing the CBTi (n = 3); observational field notes and transcripts of intervention development meetings (n = 9) and stakeholder engagement meetings (n = 2); and informal discussions with staff developing the CBTi (n = 8). Data collection and thematic analysis were guided by Normalisation Process Theory (NPT).
The process evaluation showed two domains of work necessary to develop a CBTi that made sense to stakeholders, and that could be delivered as part of an RCT. For the psychologists developing the content of the CBTi, a growing understanding of the complexity of FoF highlighted the need for an individualised rather than a manualised intervention. For the research team, the work involved adapting the structures and processes of the RCT to address preliminary concerns over the acceptability and feasibility of the proposed CBTi.
Theory-based approaches to process evaluation can sensitise researchers to contested understandings about proposed interventions that could undermine implementation. Drawing on the coherence construct of NPT, this study emphasises the nature and extent of work required to ensure an intervention makes sufficient sense to key stakeholders in order to maximise chances of successful implementation.
跌倒恐惧（FoF）在老年人中普遍存在（高达50%），会对身体和社交活动、情绪及生活质量产生负面影响。本文探讨一种针对跌倒恐惧的认知行为疗法干预（CBTi）的开发、可接受性和可行性。
本文报告了一项在英国进行的随机对照试验（RCT）中CBTi开发阶段的过程评估，采用了人种学方法。数据包括：对患者及护理人员（n = 16）、诊所工作人员（n = 6）以及开发CBTi的心理学家（n = 3）的访谈；干预开发会议（n = 9）和利益相关者参与会议（n = 2）的观察性现场记录及文字记录；以及与开发CBTi的工作人员的非正式讨论（n = 8）。数据收集和主题分析以规范化过程理论（NPT）为指导。
过程评估表明，要开发出对利益相关者有意义且可作为RCT一部分实施的CBTi，需要两个工作领域。对于开发CBTi内容的心理学家来说，对跌倒恐惧复杂性的认识不断加深，凸显了需要一种个性化而非手册化的干预措施。对于研究团队而言，工作涉及调整RCT的结构和流程，以解决对拟议的CBTi的可接受性和可行性的初步担忧。
基于理论的过程评估方法可以使研究人员敏锐地意识到对拟议干预措施存在的有争议的理解，这些理解可能会破坏实施。借鉴NPT的连贯性构建，本研究强调了确保一项干预措施对关键利益相关者有足够意义以最大化成功实施机会所需工作的性质和范围。
