Evidence-Based Implementation Process for the Development of an Assistive Technology Self-Management Intervention

PURPOSE: The design of health interventions requires a systematic approach, informed by theory, with a solid rationale for design and explicit reporting of the process used to develop the intervention. However, there is little systematic operational guidance about how best to develop complex occupational therapy interventions to reduce the gap between practice and evidence. The purpose of this study was to use an evidence-based and theory-driven systematic method for the development of an assistive technology (AT) self-management intervention for community-living older Hispanics with functional limitations.

DESIGN: We used the Evidence-Based Implementation Intervention Process design to direct the choice of the most appropriate components of the AT self-management program. The intervention was developed considering three main components: theory, evidence, and practical issues. Since this is method design research, no participants were recruited for this study. We used a four-step approach, consisting of guiding questions, to direct the choice of the most appropriate components for the intervention: (1) identifying the problem (Who needs to do what, differently?), (2) assessing the problem (Using a theoretical framework, which barriers and enablers need to be addressed?), (3) forming possible solutions (Which intervention components [behavior change techniques and modes of delivery] could overcome the modifiable barriers and enhance the enablers?), and (4) evaluating the selected intervention (How can behavior change be measured and understood?). Qualitative content analysis was used to identify the barriers and enablers for using AT devices in previous studies with older Hispanics.

RESULTS: A working version of the Assistive Technology Life Enhancement Program was designed that aimed to facilitate the use of AT strategies among community-living older Hispanics with functional limitations. We used the Theoretical Domain Framework to identify barriers and enablers to the uptake of AT devices and to guide the choice of intervention components. The intervention has explicit guiding principles and will be delivered by trained community lay facilitators via eight weekly interactive small-group workshops. We also produced videos and visual handouts of AT devices and strategies to increase efficiency and safety during the performance of daily living activities. We chose outcome measures in order to assess the mediating mechanisms of behavior change.

DISCUSSION: The use of this systematic and rigorous scientific method to develop an evidence-based and theory-driven intervention was effective for directing the choice of the most appropriate components of the AT intervention. These results further support the use of a systematic framework to guide researchers through a comprehensive intervention development process.

IMPACT STATEMENT: These findings provide initial support for occupational therapy practitioners to use the four-step theory-driven systematic method for the development of interventions designed to change clients’ health behaviors.