Evaluation Methods for Assessing Users' Psychological Experiences of Web-Based Psychosocial Interventions: A Systematic Review.

BACKGROUND: The use of Web-based interventions to deliver mental health and behavior change programs is increasingly popular. They are cost-effective, accessible, and generally effective. Often these interventions concern psychologically sensitive and challenging issues, such as depression or anxiety. The process by which a person receives and experiences therapy is important to understanding therapeutic process and outcomes. While the experience of the patient or client in traditional face-to-face therapy has been evaluated in a number of ways, there appeared to be a gap in the evaluation of patient experiences of therapeutic interventions delivered online. Evaluation of Web-based artifacts has focused either on evaluation of experience from a computer Web-design perspective through usability testing or on evaluation of treatment effectiveness. Neither of these methods focuses on the psychological experience of the person while engaged in the therapeutic process. OBJECTIVE: This study aimed to investigate what methods, if any, have been used to evaluate the in situ psychological experience of users of Web-based self-help psychosocial interventions. METHODS: A systematic literature review was undertaken of interdisciplinary databases with a focus on health and computer sciences. Studies that met a predetermined search protocol were included. RESULTS: Among 21 studies identified that examined psychological experience of the user, only 1 study collected user experience in situ. The most common method of understanding users' experience was through semistructured interviews conducted posttreatment or questionnaires administrated at the end of an intervention session. The questionnaires were usually based on standardized tools used to assess user experience with traditional face-to-face treatment. CONCLUSIONS: There is a lack of methods specified in the literature to evaluate the interface between Web-based mental health or behavior change artifacts and users. Main limitations in the research were the nascency of the topic and cross-disciplinary nature of the field. There is a need to develop and deliver methods of understanding users' psychological experiences while using an intervention.

Community integration after traumatic brain injury: a systematic review of the clinical implications of measurement and service provision for older adults.

OBJECTIVE: To explore the scope, reliability, and validity of community integration measures for older adults after traumatic brain injury (TBI). DATA SOURCES: A search of peer-reviewed articles in English from 1990 to April 2011 was conducted using the EBSCO Health and Scopus databases. Search terms included were community integration, traumatic brain injury or TBI, 65 plus or older adults, and assessment. STUDY SELECTION: Forty-three eligible articles were identified, with 11 selected for full review using a standardized critical review method. DATA EXTRACTION: Common community integration measures were identified and ranked for relevance and psychometric properties. Of the 43 eligible articles, studies reporting community integration outcomes post-TBI were identified and critically reviewed. Older adults' community integration needs post-TBI from high quality studies were summarized. DATA SYNTHESIS: There is a relative lack of evidence pertaining to older adults post-TBI, but indicators are that older adults have poorer outcomes than their younger counterparts. The Community Integration Questionnaire (CIQ) is the most widely used community integration measurement tool used in research for people with TBI. Because of some limitations, many studies have used the CIQ in conjunction with other measures to better quantify and/or monitor changes in community integration. CONCLUSIONS: Enhancing integration of older adults after TBI into their community of choice, with particular emphasis on social integration and quality of life, should be a primary rehabilitation goal. However, more research is needed to inform best practice guidelines to meet the needs of this growing TBI population. It is recommended that subjective tools, such as quality of life measures, are used in conjunction with well-established community integration measures, such as the CIQ, during the assessment process.

An exploration of nurses' perceptions regarding the implementation of a best practice guideline on the assessment and management of foot ulcers for people with diabetes.

The aim of this qualitative study was to explore nurses' perceptions regarding the implementation of a best practice guideline (BPG) on the assessment and management of foot ulcers for people with diabetes. Fourteen nurses from a community care setting and three hemodialysis units participated in five focus groups and one individual interview. The findings focus on key points regarding the impact of BPG implementation in the areas of patient outcomes, nursing practice, and interdisciplinary teamwork.

A case management experience: implementing best practice guidelines in the community.

This article discusses the implementation of a best practice guideline (BPG) in a community setting using a case management model The role of the case manager is presented as well as the process of evaluation. Challenges to implementing a BPG in a community setting are also addressed.

Nursing students and clinical instructors' perceptions on the implementation of a best practice guideline.

A university nursing program in Ontario, Canada initiated the process of implementing the Registered Nurses' Association of Ontario best practice guideline (BPG) on smoking cessation into the curriculum. This study explored nursing students' and clinical instructors' perception of the BPG in their practice to support faculty in the development of a curriculum that promotes smoking cessation and the competencies necessary for graduates to implement health promotion skills in practice. Four student nurses and two clinical instructors participated in semistructured interviews. Four major themes were identified through the data analysis process: personal and professional self, health "preaching," developmental perspective and environmental constraints. This study presents a curricular model for health promotion practice incorporating the components of primary health care, health promotion counseling, smoking cessation BPG, and sociopolitical context.

Implementation of a diabetic foot management best practice guideline (BPG) in hemodialysis units.

The aim ofthis study was to examine the impact of introducing the Registered Nurses' Association of Ontario Best Practice Guideline (BPG), Assessment and management of foot ulcers for people with diabetes (2005), on foot ulcer incidence, recurrence, and amputation rate in adult diabetic clients who are undergoing chronic hemodialysis treatments. Fifty-seven individuals from three hemodialysis units participated in the study. Data were collected at three points in time over a 15-month period. A significant reduction in the number of wounds was noted (p < 0.05) from time one to time three, and the grade of wounds (p < 0.01). However, five new amputations were reported Although implementation of the BPG showed a positive patient outcome, further research needs to be conducted with a larger sample size.

"Surviving": registered nurses' experiences in a baccalaureate nursing program.

In 2000, one Canadian university began offering a 12-month baccalaureate program to provide registered nurses (RNs) with a condensed program to expedite baccalaureate preparation. The paucity of current literature regarding returning RNs' experiences emphasized the need to explore these students' perceptions regarding their educational experiences. Twelve participants were interviewed for this descriptive/exploratory study. A major theme of "surviving" emerged from the qualitative analysis. Surviving embraced the themes of "the quest", "the struggle", and "the aftermath". Implications for nursing curriculum and program development and recommendations for research are discussed.

Integration of chronic illness care into a primary healthcare focused nursing curriculum.

Staggering statistics highlight the impact of chronic illness globally on the health of individuals and communities and in the global arena. Despite nursing's potential role to ameliorate this situation, nursing curricula is traditionally weak in this area. This article highlights one nursing program's third year baccalaureate chronic illness courses that were developed within a primary healthcare framework.

Adult day care: northern perspectives.

This qualitative study explores older adults', caregivers', and nurses' perceptions regarding adult day care (ADC). The study took place in two small towns and one small city in the northern interior region of British Columbia, Canada, with the intent to develop ADC programs that reflect the needs of older persons and their caregivers. The 32 participants contributed their perceptions in focus groups and individual interviews. The interviews, in this descriptive/exploratory study, were audiotaped, transcribed verbatim, and analyzed using inductive, qualitative techniques. The participants acknowledged ADC services as essential to the health and well-being of older adults and their caregivers. The major themes that emerged were need for respite; aging in place; ADC programming; program characteristics; staff knowledge, skills, and attitudes; and northern perspectives. The study participants identified a number of possible reasons for underuse of ADC programming in the north. This study provides information that can facilitate the grounding of ADC policy within the clients' perspectives and a northern context. The participants' thoughts also highlight areas of policy that have broad applicability to the provision of services to the elderly in any setting.