Читать книгу Nursing and Health Interventions - Souraya Sidani - Страница 21

Individuality of clients adds to the complexity of real‐world practice. In addition to their experience of co‐occurring health problems, clients vary in their sociodemographic and health profiles, and most importantly differ in their beliefs about health in general and the presenting health problem such as possible causes of the problem. These beliefs influence clients' health behaviors and shape their preferences for treatment (De las Cuevas et al., 2018). Respecting their beliefs and accounting for their preferences are principles of client‐centered care that are gaining wide interest in intervention research. This is evident in: (1) calls to determine the social acceptability, in addition to clinical effectiveness and economic efficiency, of interventions (Staniszewska et al., 2010), and to design tailored interventions that customize interventions to individual clients' characteristics and preferences (Radhakrishan, 2012); and (2) widening recognition of the utility of pragmatic and preference trials for evaluating interventions. Clients also differ in their response to interventions: some experience improvement in the health problem, whereas others show no change or even deterioration. The latter subgroups of clients may require modification of their treatment, also referred to as adaptive interventions. The modification or adaptation may include a range of possibilities such as intensifying the interventions (e.g. increasing its dose) or providing different ones (e.g. stepped‐up care) based on their responses (Hekler et al., 2018). Advances in health technology are facilitating the design and delivery of adaptive interventions, and innovative research designs are proposed to evaluate them. Planned subgroup analysis can be applied to determine the profiles of clients who most benefit from the intervention.