As noted, there is a myriad of measures available to evaluate the impact of a behavioral intervention, each with its associated strengths and weaknesses, as well as a variety of ways to assess intervention processes and implementation issues. There is also a number of ways to categorize these measures. A great deal of variability in terminology exists in the field of measurement. Measures can be classified according to measurement scale (e.g., ordinal vs. continuous); as subjective (e.g., observer ratings, participants evaluation of an intervention) or objective (biomarkers, errors on a task, or time to complete a task); or whether they are qualitative (e.g., responses in a focus group, interview data) or quantitative (e.g., responses to a standardized questionnaire or physiological indices); or according to stakeholder viewpoint (e.g., clinical/health outcomes or economic/cost outcomes). In addition, some measures are monotrait—they measure a single trait (e.g., the Center for Epidemiological Studies—Depression [CES-D] is used to measure depressive symptoms), whereas others are multitrait—they measure a variety of traits or aspects of behavior (e.g., the Symptoms Checklist-90-Revised (SCL-90-R) is used to measure nine primary symptoms). Recognizing these distinctions, we choose to discuss them according to method of assessment (e.g., self-report, performance indices) and, where possible, according to the target level of our socioecological intervention systems model (Chapter 1). These categories are not necessarily mutually exclusive. Our intent is not to provide a comprehensive list of measures, as this would be rather daunting and beyond the scope of this chapter, given the large number of domains included in behavioral intervention research. Instead, we provide examples of the types of measures that are commonly used in behavioral intervention research and the formats typically used for data collection (Table 14.2). Our focus is on highlighting issues that should be considered when selecting measures for a behavioral intervention study.
TABLE 14.2 Overview of the Primary Outcome Measures for the REACH II Trial in Relation to Intervention Component, Trial Objective, and Treatment Strategies
Treatment Strategies and Techniques
Primary Outcome Measure
? Provide educational materials on self-care and preventative health practices (Health Passport, Caregiver Notebook)
? Demonstrate and review use of Health Passport
? Instruct in healthy behaviors (e.g., nutrition, remembering medical appointments, adhering to medication schedule)
? Refer to healthy living feature of computerized phone system
? Self-Care Scale:
The caregiver's diligence in looking after his or her health was assessed using 11 questions, such as getting enough rest when sick, seeing a doctor when you thought you should, and drinking or smoking more than usual (Belle et al., 2006).
Enhance the caregiver's ability to manage ADL/IADL and behavioral problems
? Provide educational materials on symptoms of dementia and managing behaviors (Caregiver Notebook)
? Engage in structured problem solving and brainstorming of strategies
? Provide a written behavioral prescription that specifies step-by-step strategies to manage troublesome behaviors
? Demonstrate and practice specific strategies using role-play
? Refer to problem behavior feature of computerized phone system
? Three questions assessing the primary domains of the Revised Memory and Behavior Problem Checklist (i.e., memory, depression, and disruption; Teri et al., 1992) were used to assess change in patient problem behaviors at baseline and follow-up.
Increase the caregiver's knowledge about the consequences of stress and enhance the caregiver's skills and strategies for managing the burden of care
? Provide educational materials on safety, caregiving, and stress (Caregiver Notebook)
? Instruct in and practice three stress management techniques (breathing exercise, music, stretching exercises)
? Refer to stress management feature on computerized phone system
? The brief (12-item) version of the Caregiver Burden Interview (Bedard et. al., 2001; Zarit et al., 1985) was used. However, because one of the questions was not appropriate for caregivers of care recipients who were institutionalized at the
TABLE 14.2 Overview of the Primary Outcome Measures for the REACH II Trial in Relation to Intervention Component, Trial Objective, and Treatment Strategies (Continued)
Treatment Strategies and Techniques
Primary Outcome Measure
6-month follow-up (Do you feel that you don't have as much privacy as you would like because of [care recipient's name]?], caregiver burden was based on the sum of 11 questions (e.g., "Feel stressed between caring for CR and meeting other responsibilities?").
? Provide education about importance of pleasant events and emotional well-being (Caregiver Notebook)
? Instruct in and practice strategies for engaging in pleasant events
? Instruct in and role-play strategies for mood management and use of Thought Record
? Establish schedule of pleasant events
? The 10-item version of the Center for Epidemiological Studies—Depression Scale (CES-D; Radloff, 1977) was used to assess depression.
Enhance the caregiver's emotional and social support, support with caregiving activities
? Provide education about importance of social support (Caregiver Notebook)
? Instruct in how to access community resources
? Practice and role-play strategies to enhance communication with health care providers and family members
? Reinforce participation in telephone support groups
? Refer to resource guide; communication and respite features of computerized phone system
? Social support was assessed using 10 items assessing three domains of support: (a) received support (3 items; Barrera, Sandler, & Ramsay, 1981; Krause, 1995); (b) satisfaction with support (3 items; Krause, 1995; Krause & Markides, 1990); and (c) negative interactions/support (4 items; Krause, 1995).
ADL, activities of daily living; IADL, instrumental activities of daily living. Source: Adapted from Belle et al. (2006).