Making sense of a cognitive behavioural therapy intervention for fear of falling: qualitative study of intervention development

BMC Health Services Research

Steve W Parry¹  Neil Sabin³  Vincent Deary²  Claire Bamford⁴  Tracy L Finch⁴ 

[1] Institute for Ageing and Health, Newcastle University and Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK;School of Life Sciences, Northumbria University, Northumberland Building, Newcastle upon Tyne NE1 8ST, UK;STRIDE office, Newcastle University, 3/4 Claremont Road, Newcastle, Tyne and Wear NE1 7RU, UK;Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne NE2 4AX, UK

关键词: Intervention development;    Normalisation process theory;    Process evaluation;    Ethnography;    Falls;    Cognitive behavioural therapy;    Fear of falling;   

Others  :  1126158
DOI  :  10.1186/1472-6963-14-436

 received in 2014-03-03, accepted in 2014-09-17,  发布年份 2014

【 摘 要 】

Background

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.

Methods

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).

Results

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.

Conclusions

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.

【 授权许可】

   
2014 Finch et al.; licensee BioMed Central Ltd.

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