MAPPING AN INTERVENTION
On the basis of the information gleaned from the eight considerations outlined earlier, it should be possible to draft: the potential treatment goals of an intervention; its targeted population; its theory base; its specific objectives; primary (immediate, proximal), secondary, and distal measures; and the key potential components that will be delivered. In doing so, conducting a task analysis of a potential intervention can be helpful. A task analysis involves breaking down an intervention into its operational components to assure that there is complete alignment between the stated problem, targeted population, goals, objectives, and activities of an intervention and proposed outcomes.
Figure 3.2 provides an example of a task analysis of the Get Busy Get Better, Helping Older Adults Beat the Blues (GBGB) intervention. As illustrated, this approach is helpful for several reasons: it provides a visual for aligning the identified problem and treatment goals with specific treatment objectives, key activities and expected outcomes; it provides a roadmap for planning for fidelity or what will need to be monitored to assure that the intervention is delivered as intended (see Chapter 12); and it can serve as the basis for identifying other considerations such as staffing and budget needs, and feasibility and cost.
The GBGB intervention shown in Figure 3.2 was designed as a depression intervention for older African Americans and for screening by telephone and delivery in homes by senior center staff. Briefly, GBGB was based upon social, ecological, and behavioral frameworks for understanding depression among older African Americans with depressive symptoms. In keeping with these frameworks, the intervention goal was to reduce depressive symptoms and improve quality of life by mitigating negative environmental circumstances (e.g., difficulty traveling to physician’s office, finance strain) infringing on mood and participation in positive activities. To meet this goal, the intervention had five objectives: to enhance participants’ understanding of depression and ability to recognize their own symptoms; to identify unmet care needs; to link participants to needed services and resources; to enhance engagement in desired activities; and to reduce situational distress that may be preventing activity engagement. To meet each of these objectives, a series of activities was enacted as shown. The premise of the intervention is that each of these objectives works together to reach the treatment goal and is necessary in order to achieve the desired outcomes. By conducting this task analysis, it was determined that there are well-tested protocols for stress reduction and behavioral activation, which could be incorporated into the intervention. Furthermore, through pilot testing, it was discovered that pain from chronic diseases was not well addressed by any of the objectives, yet was interfering with the ability of participants to engage in meaningful activities. Also, motivational interviewing techniques were subsequently identified as important to use to boost the behavioral activation protocol. Thus, a new component on pain management was added to this intervention along
Figure 3.2 Tasks analysis of the Get Busy Get Better intervention.
with motivational interviewing techniques to better address the behavioral activation objective. This illustrates how a task analysis can serve as a working document to guide testing phases and intervention refinements.
Figure 3.2 reflects the anatomy of the GBGB intervention. However, an intervention may have only one, two, or three objectives and one or two associated activities. Obviously, complex health or social problems will require a multicomponent approach such as GBGB, whereas less complex behavioral change-oriented interventions may require only one or two objectives, components, and/or singular modalities (e.g., impacting cognition only). A task analysis can be a helpful exercise for any type of intervention.