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ASSIGNMENT 1
JANUARY SEMESTER 2017
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CONTENTS
PAGES

The Probability And Non-Probability Sampling Techniques Used

In Nursing Research.
1.0 Introduction 4
2.0 Probability sampling technique 5
2.1. Simple random sampling 5
2.2 Stratified random sampling 6
2.3 Systematic random sampling 6
2.4 Cluster or multistage sampling 7
3.0 Nonprobability sampling technique 7
3.1 Purposive Sampling 7
3.2 Convenient Sampling 8
3.3 Quota sampling 9
3.4 Snowball sampling 9
4.0 Conclusion 9

Validity And Reliability Reflect Credibility Of A Research Report.

1.0 Introduction 10
2.0 Reliability 10
2.1 Validity 12
3.0 Steps taken to ensure validity and reliability reflect credibility 12
of a research report.
3.1. Triangulation 12
3.2 Multiple 13
3. 3 Expert Consensual Validation From Others 13
3.4 Member Check 14
3.5 Searching For Disconfirming Evidence 15
3.6 Checking For Representativeness 15
3.7 Thick Description 15
4.0 Conclusion 16

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The Interventions Required To Ensure Validity And Reliability

Of A Research Report.
1.0 Introduction 17
2.0 Intervention Fidelity In The Research Project. 18
2.1 Internal Validity 18
2.2 Strategies for Enhancing Intervention Fidelity 18
2.3 Manual 19
2.4 Training 20
2.5 Monitoring Intervention Fidelity 20
3.0 Conclusion 20

REFERENCES

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THE PROBABILITY AND NON-PROBABILITY SAMPLING TECHNIQUES USED IN

NURSING RESEARCH.

1.0 Introduction

Sampling is a process of selecting representative units from an entire population of a study.

Sample selection is a key factor in research design and can determine whether research questions
will be answered before the study has even begun. Good sample selection and appropriate
sample size strengthen a study, protecting valuable time, money and resources. In the context of
healthcare research, poor design could lead to use of harmful practices, delays in new treatment
and lost opportunities for high quality care. Not every study can achieve design perfection and
researchers often seek a balance between the ideal sample and one that is feasible or convenient,
acknowledging the limitations of their design decisions. Sample selection is far from simple but
here are some of the techniques to think about as you read research and make the most out of
your research endeavors.

Sample may be defined as representative unit of a target population, which is to be

worked upon by researchers during their study. In other words, sample consists of a subset of
units which comprise the population selected by investigators or researchers to participates in
their research project. The individual entities that comprise the samples & population are known
as elements, and an element is the most basic unit about whom/which information is collected.
An elements is also known as subject in research. The most common element in nursing research
is an individual. The sample or population depends on the phenomenon under study.

It is critical to take the time to clearly identify the population of interest for the specific
research question. Nursing researchers are usually interested in answering questions about very
specific patient populations which can span an incredible array of possibilities applying to
international, national, local and organizational contexts. Research populations closely reflect
nursing specialties, some of which are gender (e.g. pregnant women) and age specific (e.g.
adolescent diabetes). It is rarely feasible to conduct a study that reaches every patient in the
population of interest, therefore a subset or sample of that population is selected for study.

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Sampling is a process of selecting representative part of the population. Thus, a carefully

carried out sampling process helps to draw a sample that represents the characteristics of the
population from which the sample is drawn. There are several methods or techniques of
sampling, however; basically sampling techniques are classified in two broad categories, i.e.
probability and nonprobability sampling techniques. So, the purpose of this task is to discuss
about probability and nonprobability sampling techniques use in nursing research.

2.0 Probability sampling technique

Probability (representative) sampling includes techniques used to select a sample that clearly
represents a specific population. Participants are randomly selected so that all members of the
population have an equal chance of being selected in the sample, eliminating the possibility of
sample selection bias.

Example:
Let's say Hospital A is interested in the opinions of all 1000 of their patients who underwent
knee surgery during the calendar year 2013 (the population). The Quality Assurance (QA)
budget will not allow for all patients to be surveyed but they want to be sure the sample
represents all patients. One way to do this is by selecting a random sample of a prespecified
number of patients.
Probability sampling technique are further classified in five subtypes : simple random
sampling, stratified random sampling, systematic random sampling, cluster or multistage
sampling and sequential sampling.

2.1. Simple random sampling

A simple random sample is obtained by choosing elementary units in search a way that each unit
in the population has an equal chance of being selected. A simple random sample is free from
sampling bias. However, using a random number table to choose the elementary units can be
cumbersome. If the sample is to be collected by a person untrained in statistics, then instructions
may be misinterpreted and selections may be made improperly. Instead of using a least of

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random numbers, data collection can be simplified by selecting say every 10th or 100th unit after
the first unit has been chosen randomly as discussed below. such a procedure is called systematic
random sampling.
If simple random selection was used, the desired number of patients (e.g., 200 or 20%)
would be randomly selected from a complete list of 1000 patients using random numbers
between 1 and 1000. Random numbers can be generated using a spreadsheet program or an
online randomizer that can export a set of numbers into spreadsheet programs.

2.2 Stratified random sampling

This method is used for heterogeneous population. It is a probability sampling technique wherein
the researcher divides the entire population into different homogeneous subgroups or strata, &
then randomly selects the final subjects proportionally from the different strata.
A stratified random sample could be selected for a more targeted approach. If the hospital
was aware that there were only 400 women who had knee surgery in that year and wanted the
sample to represent known gender proportions for all patients having knee surgery they could
stratify the populations first. In this case, the patient population would be divided (stratified)
according to gender before simple random selection was used to identify 40% (n=80) female and
60% (n=120) male patients for the sample.

2.3 Systematic random sampling

A systematic random sample is obtained by selecting one unit on a random basis and choosing
additional elementary units at evenly spaced intervals until the desired number of units is
obtained. For example, there are 100 patients under you control. You want a sample of 20 from
these 100 and you have their names listed on a piece of paper may be in an alphabetical order. If
you choose to use systematic random sampling, divide 100 by 20, you will get 5. Randomly
select any number between 1 and five. Suppose the number you have picked is 4, that will be
your starting number. So patient number 4 has been selected. From there you will select every
5th name until you reach the last one, number one hundred. You will end up with 20 selected
patients.

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2.4 Cluster or multistage sampling

It is done when simple random sampling is almost impossible because of the size of the
population. Cluster sampling means random selection of sampling unit consisting of population
elements. Then from each selected sampling unit, a sample of population elements is drawn by
either simple random selection or stratified random sampling. This method is used in cases
where the population elements are scattered over a wide area, and it is impossible to obtain a list
of all the elements. The important thing to remember about this sampling technique is to give all
the clusters equal chances of being selected.

3.0 Nonprobability sampling technique

The essential difference between probability and non-probability sampling is the notion of
random selection (Babbie 2004). Consequently, non-probability samples cannot depend upon the
rationale of probability theory, and therefore may or may not represent the population well,
which is often difficult to establish.
Non-probability sampling (non-representative) although usually systematic and capable
of answering research questions, can suffer from issues associated with sample selection bias.
Most nursing research involves nonprobability sampling despite the fact that it is not as good as
probability sampling at controlling extraneous variables.

3.1 Purposive Sampling

Purposive sampling, a form of non-probability sampling, targets a particular group of people, and
entails selection of population elements on the basis of the researchers judgment that they are
representative of the larger population of interest. It thus assumes homogeneity (Lohr 1999).
Purposive sampling is useful for situations where sampling for proportionality is not the
primary concern. However, an unknown proportion of the population may be excluded (i.e. those
who declined to participate). Moreover, using purposive sampling in heterogeneous populations
carries a high risk of sampling bias because participants are self-selected, and may be atypical of
the population of interest in relation to critical variables (Babbie 2004).
In purposive sampling, we sample with a purpose in mind. We usually would have one or
more specific predefined groups we are seeking.

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Example :
Let's say the QA nurse at Hospital A is interested in patient opinions about the new
hospital admission and discharge process for knee surgery patients. Owing to budget limitations
and the fact that the QA nurse only works 1 day/week, the nurse uses a convenient purposive
sample to survey patients who experience knee surgery every Friday when she is in the hospital.
This particular convenience sample may be representative of patients who experienced knee
surgery on Fridays (the sample); however, it would not necessarily represent all patients who
experienced knee surgery in that hospital (the population). There may be differences in the
characteristics of patients having surgery on Fridays. Perhaps the surgeons who operate on
Fridays mostly see sports-injured male patients (age range 2535 years) with private health
insurance compared with the surgeons who operate during the remainder of the week serving
male and female publicly insured patients (age range 3555 years). Potential differences in
sample characteristics such as age, gender, level of presurgery fitness, income, education and
employment could be unique to the sample and fail to answer the question for all patients in the
hospital.

3.2 Convenient sampling

Convenience samples are recruited based on accessibility to the researcher. This sampling is a
weakest form of non-probability sampling but is most commonly used. It is also the most
commonly used sampling method in many disciplines. This entails using the most conveniently
available people as study participants. This is also called as accidental sampling.
Although convenience samples are used widely by researchers, determination of the
representativeness of these samples are not generally documented in nursing research. Risk of
bias in heterogeneous population. quite high defined as use of most conveniently available
subjects for use in a study.
An example is a nurse who conducts an observational study of women delivering twins at
the local hospital is also relying on a convenience sample. The problem with convenience
sampling is that available subjects might be atypical of the population of interest with regard to
critical variables.

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3.3 Quota sampling

Quota sampling does not require sophisticated skills or lot of effort and it is surprising that so
few researchers use this strategy. A quota sample is one in which the researcher identifies
population strata and determines how many participants are needed from each stratum. By using
information about population characteristics, researchers can ensure that diverse segments are
represented in the sample, preferably in the proportion in which they occur in the population.

3.4 Snowball Sampling

In snowball sampling, you begin by identifying someone who meets the criteria for inclusion in
your study. You then ask them to recommend others who they may know who also meet the
criteria. Although this method would hardly lead to representative samples, there are times when
it may be the best method available. Snowball sampling is especially useful when you are trying
to reach populations that are inaccessible or hard to find. An example is snowball sampling
where participants guide the researcher to the next participant, via acquaintances or social
networks. Snowballing is useful when studying hard to reach groups but can result in a sample
bias. Convenience sampling is the least rigorous technique used and can result in poor-quality
data, which should be balanced against resource savings (time and money) or convenience.

4.0 Conclusion
Sample selection is far from simple so check your research design and sample selection plan
with an expert statistician or research consultant early, and before the data collection begins.
Designing a study or writing research questions to suit a sample that is merely convenient to
reach is dangerous and readers should always be alert to signs of poor practice in sample
selection. Great samples are worth the effort.

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VALIDITY AND RELIABILITY REFLECT CREDIBILITY OF A RESEARCH

REPORT.

1.0 Introduction

Key indicators of the quality of a measuring instrument are the reliability and validity of the
measures. In addition, the responsiveness of the measure to change is of interest in many
health care applications where improvement in outcomes as a result of treatment is a primary
goal of research. Data sources for measures used in pharmacy and medical care research
often involve patient questionnaires or interviews. Measures using patient self-report
include quality of life, satisfaction with care, adherence to therapeutic regimens, symptom
experience, adverse drug effects, and response to therapy (e.g., pain control, sleep
disturbance). In addition, measures can be developed.
Validity and reliability are important concepts in research. The everyday use of these terms
provides a sense of what they mean (for example, your opinion is valid; your friends are
reliable). In research, however, their use is more complex.
Suppose you hear about a new study showing depression levels among workers declined
during an economic downturn. You learn that this study used a new questionnaire to ask workers
about their mental health over a number of years. You decide to take a closer look at the strength
of this new questionnaire. Was it valid? Was it reliable? To assess the validity and reliability of a
survey or other measure, researchers need to consider a number of things. This paper is focuses
to the steps has to be taken to ensure validity and reliability reflect credibility of a research
report.

2.0 Reliability
Reliability has to do with the quality of measurement. In its everyday sense, reliability is the
"consistency" or "repeatability" of your measures. Before we can define reliability precisely we
have to lay the groundwork. First, you have to learn about the foundation of reliability, the true
score theory of measurement.

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Along with that, you need to understand the different types of measurement error because errors
in measures play a key role in degrading reliability. With this foundation, you can consider the
basic theory of reliability, including a precise definition of reliability. There you will find out
that we cannot calculate reliability -- we can only estimate it.
Because of this, there a variety of different types of reliability that each have multiple
ways to estimate reliability for that type. In the end, it's important to integrate the idea of
reliability with the other major criteria for the quality of measurement -- validity -- and develop
an understanding of the relationships between reliability and validity in measurement.
The term Reliability is a concept used for testing or evaluating quantitative research, the
idea is most often used in all kinds of research. At the outset, researchers need to consider
the face validity of a questionnaire. That is, to a layperson, does it look like it will measure what
it is intended to measure? In our example, would the people administering and taking the
questionnaire think it a valid measure of depression? Do the questions and range of response
options seem, on their face, appropriate for measuring depression?
Researchers also need to consider the content validity of the questionnaire; that is, will it
actually measure what it is intended to measure. Researchers often rely on subject-matter experts
to help determine this. In our case, the researchers could turn to experts in depression to consider
their questions against the known symptoms of depression (e.g. depressed mood, sleeping
problems and weight changes).
When questionnaires are measuring something abstract, researchers also need to establish
its construct validity. This refers to the questionnaires ability to measure the abstract concept
adequately. In this case, the researchers could have given a questionnaire on a similar construct,
such as anxiety, to see if the results were related, as one would expect. Or they could have given
a questionnaire on a different construct, such as happiness, to see if the results were the opposite.
It may sometimes be appropriate for researchers to establish criterion validity; that is, the extent
to which the measurement tool is able to produce accurate findings when compared to a gold
standard. In this case, the gold standard would be clinical diagnoses of depression. The
researchers could see how their questionnaire results relate to actual clinical diagnoses of
depression among the workers surveyed.

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2.1 Validity

The extent to which a variable or intervention measures what it is supposed to measure or

accomplishes what it is supposed to accomplish. Researchers also need to consider the reliability
of a questionnaire. Will they get similar results if they repeat their questionnaire soon after and
conditions have not changed? In our case, if the questionnaire was administered to the same
workers soon after the first one, the researchers would expect to find similar levels of depression.
If the levels havent changed, the repeatability of the questionnaire would be high. This is
called test-retest reliability.
Another aspect of reliability concerns internal consistency among the questions. Do
similar questions give rise to similar answers? In our example, if two questions are related to
amount of sleep, the researchers would expect the responses to be consistent.
Researchers also look at inter-rater reliability; that is, would different individuals
assessing the same thing score the questionnaire the same way. For example, if two different
clinicians administer the depression questionnaire to the same patient, would the resulting scores
given by the two be relatively similar?
If our depression researchers were sloppy in ensuring the validity or reliability of their
questionnaire, it could affect the believability of their studys overall results. Although you can
never prove reliability or validity conclusively, results will be more accurate if the measures in a
study are as reliable and valid as possible.

3.0 Steps taken to ensure validity and reliability reflect credibility of a research report.

3.1. Triangulation

Triangulation refers to the use of two or more data sources, methods, investigators, theoretical
perspectives and approaches to analysis in the study of a single phenomenon and then
validating the congruence among them. The major goal of triangulation is to circum vent
the personal biases of investigators and overcome the deficiencies intrinsic to single-
investigator, single-theory, or single-method study thus increasing the validity of the study
(Denzil 1989).

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Triangulation is proposed by many nurse researchers as a means of solving the

quantitative/qualitative debate and integrating the two approaches. While this view is accurate, it
does not take into account the possible complexity and usefulness of triangulation, nor does it
fully recognize the two goals of triangulation: confirmation and completeness of data. It is
argued that the view that triangulation is merely the combination of different methods of
investigation is a narrow one, and it is recommended that nurse researchers increase their
utilization of the four less frequently used types of triangulation: data, investigator, theoretical
and unit of analysis.
When using triangulation of methods, researchers should also consider whether the use of
within-method triangulation would be beneficial to their study. Sequential use of quantitative and
qualitative methods to develop and refine tools of enquiry may also be more effective for certain
studies than the more usual simultaneous use. The 'triangulation state of mind', the conscious
employment of multiple data sources and methods to cross-check and validate findings
continuously, should permeate all studies and lead to the goal of confirmation. Above all,
triangulation must be chosen deliberately, for the correct reasons, and an adequate description of
the rationale, planning and implementation of procedures should be given in reports, to give
credence to the emerging method of research.

3.2 Multiple

Repetitions of measurement over or long period of time, at different points of time, in different
situations or settings and by different persons. Multiple strategies to enhance the patient
experience of nursing time are warranted and should address how much time nurses spend with
patients as well as how they spend that time. Patterns of overlapping and competing time
structures for nurses should be identified and evaluated for their effect on physical time available
for patient care and the psychological experiences of time by nurses and patients.

3. 3 Expert Consensual Validation From Others

Familiar with the topic under study at various stages of the research process. This involves
independent analysis of the data by others (e.g. research colleagues, a judge panel or

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participant informants. (For example, following each initial category generation during
analysis - independent fellow researchers or other experts in the field are invited to
generate their own category system. This is them compared with the researchers)

3.4 Member Checks

In qualitative research, a member check, also known as informant feedback or respondent

validation, is a technique used by researchers to help improve the accuracy, credibility, validity,
and transferability (also known as applicability, internal validity, or fittingness) of a study. There
are many subcategories of members checks, including; narrative accuracy checks, interpretive
validity, descriptive validity, theoretical validity, and evaluative validity. In many member
checks, the interpretation and report (or a portion of it) is given to members of the sample
(informants) in order to check the authenticity of the work. Their comments serve as a check on
the viability of the interpretation.
Member checking can be done during the interview process, at the conclusion of the
study, or both to increase the credibility and validity (statistics) of a qualitative study. The
interviewer should strive to build rapport with the interviewee in order to obtain honest and open
responses. During an interview, the researcher will restate or summarize information and then
question the participant to determine accuracy.
Member checks completed after a study are completed by sharing all of the findings with
the participants involved. This allows participants to critically analyze the findings and comment
on them. The participants either affirm that the summaries reflect their views, feelings, and
experiences, or that they do not reflect these experiences. If the participants affirm the accuracy
and completeness, then the study is said to have credibility. These member checks are not
without fault, but serve to decrease the incidence of incorrect data and the incorrect interpretation
of data. The overall goal of this process is to provide findings that are authentic, original and
reliable.

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3.5 Searching For Disconfirming Evidence

In this step there is an active search for disconfirmation of what is believed to be true.
A proposition deserves some degree of trust only when it has survived serious attempts to
Curationis, VoL 16, No. 2, June 1993 37falsify it (Cronbach in Lather 1986: 67). Searching
for disconfirming evidence involves both purposive sampling and prolonged engagement
with informants in the field. Purposeful sampling allows the researcher to include informants
who may differ from key informants in critical ways. This purposeful sampling of individuals
and the inclusion of conflicting as well as complementary accounts strengthens the
description. One varies or contrasts the conditions as methodically as possible in order to
determine what has an impact on the phenomenon in question (Corbin & Strauss 1990).

3.6 Checking For Representativeness

This step includes checking for the representativeness of the data as a whole, of the coding
categories and of the examples used to analyze and present the data.

3.7 Thick Description

Qualitative research, like its quantitative cousins, can be systematically evaluated only if their
criteria and procedures are made explicit Hence validity and reliability can only be judged
if a very detailed account of the context or setting within which the study took place and a
thorough description of the procedures from the beginning to the end is given. Most
qualitative researchers refer to this as thick description. However Lincoln and Guba (1985)
use the term auditability. Auditability means that any reader or another researcher can follow
the progression of events in the study and understand their logic. Such an account starts with
the researcher recognizing and disclosing initial assumptions, suppositions and values that
may have influenced data gathering and processing.
The account also needs to include the relationship between field notes and the
conclusions based upon them. Memos, data display charts, indicating coding instructions and

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the actual placement of data into categories and the way different elements of the data were
linked to each other, should be kept available.

4.0 Conclusion

Corbin and Strauss (1990:20) strongly urge investigators to adhere to the major criteria for
answering credibility unless there are exceptional reasons for not doing so. In such unusual
cases, researchers should know precisely how and why they depart from the criteria, say so in
their writing, and submit the credibility of their findings to the reader. If we want to develop a
valid, truthful and believable account of our qualitative studies it will be wise to take note of and
implement the critical strategies discussed unless otherwise indicated. In health care and
social science research, many of the variables of interest and outcomes that are important are
abstract concepts known as theoretical constructs. Using tests or instruments that are valid and
reliable to measure such constructs is a crucial component of research quality. In health care
and social science research, many of the variables of interest and outcomes that are
important are abstract concepts known as theoretical constructs. Using tests or instruments
that are valid and reliable to measure such constructs is a crucial component of research quality.

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THE INTERVENTIONS REQUIRED TO ENSURE VALIDITY AND RELIABILITY OF

A RESEARCH REPORT.

1.0 Introduction
Interventions, whether simple or complex, are increasing in health care in response to the
growing complexity and acuity of patients conditions. Monitoring the fidelity of implementing
interventions is challenging. A common method to assess and monitor fidelity of intervention
implementation is through a structured, reliable and valid instrument. Although an assumption
of consistency in intervention delivery is key to the conclusion that the findings are valid,
attention to both interventionist adherence and competence has not become a standard in nursing
intervention research. Intervention fidelity, defined as the adherent and competent delivery of an
intervention by the interventionist as set forth in the research plan, is fundamental to the
inference of validity in nursing intervention research. The nursing literature on intervention
fidelity has included adherence, defined it as the degree to which the prescribed elements of an
intervention have been delivered and proscribed elements avoided (Waltz, Addis, Koerner, &
Jacobson, 1993).
The attention on the interventionist's behavior distinguishes the meaning of adherence as
it is used in this task from the meaning of adherence associated with whether the client carried
out the prescribed activities or not. Competence is defined as the extent to which the
interventionist has displayed behaviors that typically engage participants in the intervention and
affect outcomes in the desired direction (Najavits & Weiss, 1994).
Because an interventionist's ability to engage participants can affect whether offered
interventions are used and have adequate opportunities to produce change, both adherence and
competence assessments are necessary for an inference of validity. The focus of this presentation
is on psychosocial interventions. These interventions are highly flexible, individualized and not
easily articulated, and difficult to judge for validity. The purpose of this paper is to present
strategies and discuss rationale for including intervention fidelity in the research project.

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2.0 Intervention Fidelity In The Research Project.

2.1 Internal Validity
In a true experiment the only difference between the experimental and control groups is the
presence of the intervention, therefore any observed differences between the two groups has to
be due to (caused by) the intervention (independent variable). The controlled conditions of the
true experiment that permits the conclusion that any differences between the control and
experimental groups are caused by the independent variable. This characteristic of a study is
called Internal Validity. A study that has internal validity has eliminated all confounding
variables by use of control groups and procedural controls, so that any differences seen between
the groups can be said to be caused by the independent variable. Any study that has confounding
variables that could also explain the differences between groups lacks internal validity and
cannot claim that differences or changes seen are due to the independent variable.
For example, a study reports that eating tomatoes reduces the risk of lung cancer. This is
an implied causal statement: eating tomatoes causes the reduced incidence of lung cancer. To be
able to make such a causal claim, a true experiment would be required. In this case, the
experiment would need to have a control group and an experimental group with subjects
randomly assigned to groups, and an active intervention. The experimental group would eat 5
tomatoes a day for 10 years, while the control group would eat only minimal tomatoes.
Otherwise, their diets would be identical in fat, carbohydrate, fiber, salt, sugar, etc. so that the
only difference between the groups would be the number of tomatoes eaten. So, this is a true
experiment. At the end of the 10 year period, the number of cases of lung cancer in each group
would be determined. If the number of lung cancer cases in the control group was significantly
higher that the tomato eating group, we could conclude that the tomatoes actually caused a
reduction in incidence of lung cancer.

2.1 Strategies for Enhancing Intervention Fidelity

Researchers incorporate strategies into their study designs to ensure that all members of the
treatment group receive all the essential elements of the intervention (Bellg et al., 2004) and that
the intervention is delivered in a comparable manner to the participants (Dumas et al., 2001;
Kerns & Prinz, 2002). The primary focus of intervention fidelity strategies is on the
interventionist. Researchers who are designing intervention fidelity strategies should address the

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training provided to the research team members who will deliver the intervention and incorporate
monitoring procedures to evaluate intervention fidelity.
Intervention fidelity strategies will be discussed, and examples from the first two authors'
studies will be presented. The first author is conducting a health promotion study to improve
family asthma management. The intervention consists of 16 small-group sessions provided in
schools to rural school-age children who have asthma and followed by one individualized home-
visit session to the family. Hereafter this first study will be referred to as the asthma management
intervention. The second author is conducting a health promotion study to reduce risky sexual
behaviors among homeless adolescents. The intervention consists of eight sessions provided to
gender-specific groups of homeless adolescents at a community health clinic that provides a
variety of services to homeless youth. Hereafter this second study will be referred to as the
sexual health intervention.
Intervention fidelity was incorporated into these studies' designs from the beginning.
Strategies for enhancing intervention integrity included developing detailed manuals of
intervention content and activities, providing training to interventionists, and monitoring the
ongoing intervention sessions.

2.2 Manual
Developing manuals that spell out the program purpose, goals, session objectives, and essential
or critical elements, such as behaviors that are to be role modeled by interventionists or the
content that must be covered, can standardize the training of interventionists (Bellg et al., 2004).
Well-developed intervention manuals or protocols are the gold standard of intervention therapies
(Kerns & Prinz, 2002). The elements covered in the manual form the basis for evaluation of
fidelity.
The conceptual framework for an intervention study clearly identifies the concepts or
constructs included in the intervention. Such concepts may include specific content that is to be
delivered and specific outcomes that are to be achieved.
For example, in the asthma management intervention, the focus is on children's skills,
knowledge, self-efficacy, and problem-solving as they face commonly occurring situations (e.g.,
asthma episodes on the school bus, when playing sports, or in the classroom). The manual is
divided into the content to be provided over the course of the intervention and includes problem-

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solving scenarios, and skills practice with metered dose inhalers and peak flow meters; self-
efficacy and knowledge about asthma are incorporated throughout the intervention. The manual
has a list of supplies needed for each of the children's sessions, the session objectives, and
specific content to be covered in each session. Woven throughout the manuals are directions
(specific instructions) or suggestions for handling different interactions in the group. Ways to
handle disruptive behaviors are identified and are developmentally appropriate for the
participants: Redirecting the disruptive child by assigning the child a specific task like helping
gather materials or writing down the class responses on the board are appropriate strategies for
this age group.

2.3 Training
Training of the interventionists was provided in both studies. Research team members bring a
wide range of skills and experiences to a study and this can influence the manner in which the
intervention is delivered. The study planners must consider the interventionists' skill sets what
they bring to the project (Bellg et al., 2004). Variance in intervention delivery can be reduced by
having a high degree of structure in the intervention design (Kerns & Prinz, 2002). Strategies for
achieving conformity across multiple interventionists include training for intervention delivery in
which (a) the philosophy of the program is discussed, (b) objectives and intervention procedures
are covered in detail, and (c) the interventionists have an opportunity to practice the necessary
skill sets needed for the intervention (Bellg et al.; Kerns & Prinz).
For example, the asthma management intervention had two different types of
interventionists: registered nurses provided the home visit education, and lay health educators
provided the small class sessions in schools to the children. The training of the registered nurses
for the home visit education consisted of educating the nurses about asthma pathophysiology,
treatment, environmental management, problem-solving for common asthma-related situations,
and the use of asthma action plans.

2.4 Monitoring Intervention Fidelity

Ongoing process evaluation was included in both interventions. Regular monitoring of
intervention delivery by using a theoretically based measure of fidelity allows researchers to

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identify variance from the studies' planned procedures or content and make corrections over the
course of intervention delivery (Baranowski & Stables, 2000; Nigg et al., 2002).
Another advantage of monitoring intervention fidelity with a structured instrument is that
the resultant measure can be used as a variable to evaluate the program outcome (Calsyn, 2000;
Nigg et al.).
Two health promotion projects with school children funded by the National Cancer
Institute exemplify the impact of monitoring intervention fidelity on study outcomes. Both
projects involved elementary school children who were provided with curricula designed to
increase fruit and vegetable consumption. By using standardized evaluation instruments and
procedures that incorporate essential components of the interventions, these research teams were
able to evaluate the efficacy of their interventions to effect behavioral change in the children and
the school environments (Calsyn, 2000).

3.0 Conclusion
Evaluation of intervention fidelity is a key element of the study design. It must be addressed
early in study development to yield useful processes and instruments for ongoing evaluation of
the intervention, both during and after the study is implemented. As Nigg and colleagues (2002)
point out, verification of treatment fidelity is integral to both the interpretation and
generalization of the research findings (p. 674). These early decisions about the use to be made
of intervention fidelity evaluation (e.g., monitoring and feedback for interventionists, or
statistical factor) will enhance the quality of the study (Bellg et al., 2004).
Furthermore, as the study proceeds and data are gathered and analyzed, this analysis can
contribute to the planning of future interventions. For example, the number of sessions attended
by a participant (Santacroce et al., 2004), the amount of content delivered (number of topics
covered:Baranowski & Stables, 2000), and even participant satisfaction with the intervention can
be measured and incorporated into the outcome evaluation (Burke et al., 2004).
Intervention fidelity is an integral component of the study design. Validity of the
outcomes of intervention studies is based in large part on the degree to which the intervention
fidelity is maintained and evaluated (Kerns & Prinz, 2002). Attention to the internal validity of
the study procedures can strengthen confidence that the study outcomes are indeed related to the
intervention.

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