Nursing and Health Interventions. Souraya Sidani

remediation. A strategy is used to frame the overall design of an intervention. For instance, conceptualizing chronic insomnia from a cognitive perspective only (Harvey et al., 2007) highlights the need for a cognitive approach for intervention. The cognitive approach focuses on information processing (e.g. beliefs about factors contributing to and consequences of insomnia). In contrast, viewing chronic insomnia as a behavioral problem (e.g. Bootzin & Epstein, 2011) indicates the need for a behavioral approach for intervention. The behavioral approach focuses on sleep‐related behaviors and habits. As such, a strategy offers general principles to guide the selection and/or design of interventions that are commensurate with the overarching conceptualization of the health problem.

      2.1.2 Interventions

The terms “intervention,” “treatment,” and “therapy” are interchangeable. Although widely used in written (e.g. books, published research reports) and verbal (e.g. case conference, end of shift report in the practice setting) communications, only a few formal definitions of interventions have been located in recent literature (Table 2.1). A thorough examination of these definitions points to two key attributes that define interventions. The first attribute is that interventions are essentially activities. They involve the application of specific techniques by the health professional delivering interventions and the clients receiving interventions. The second attribute is rationality. Rationality means that interventions are given in response to an actual or potential health problem, and directed toward attainment of desired goals. Accordingly, interventions are sets of activities performed by health professionals and clients, independently or collaboratively, to address problems experienced by clients and to achieve beneficial outcomes.

Interventions are more specific than strategies. Strategies provide general principles informing the generation of new or the selection of available evidence‐based techniques. For instance, a behavioral conceptualization of chronic insomnia provided guidance for developing the stimulus control therapy. The stimulus control therapy consists of specific recommendations for sleep behaviors (known to perpetuate insomnia) to do or avoid, and specific techniques to assist clients in carrying out these recommendations. The techniques include providing information on the association between sleep behaviors and insomnia, prompting identification of barriers and possible solutions, and encouraging self‐monitoring of sleep behaviors and parameters. These three specific techniques are described as replicable behavior change techniques designed to alter behaviors (Abraham & Michie, 2008; Carey et al., 2018).

TABLE 2.1 Formal definitions of interventions.

Field	Definition	Reference
Nursing	Deliberate cognitive, physical, or verbal activities performed with, or on behalf of, individuals and their families, that are directed toward accomplishing particular therapeutic objectives relative to individuals' health and well‐being	Grove et al. (2015)
	Actions, treatments, or technologies, that are physical, psychological, social in nature, with predicted outcomes	Forbes (2009)
Public health	Planned actions to prevent or reduce a particular health problem or the determinants of the problem	Wight et al. (2015)
	An act performed for, with, or on behalf of a person or population with the purpose to assess, improve, promote, or modify health, functioning, or health conditions	Cambon et al. (2019)
Behavior health	Coordinated sets of activities or techniques introduced at a given time and place to change the behavior of individuals, communities, or populations through a hypothesized or known mechanism	Araújo‐Soares et al. (2018)
Social/implementation science	Events within systems, aimed to disrupt the functioning of complex systems through changing relationships, displacing entrenched practice, and redistributing and transforming resources	Moore et al. (2019)
	Attempts to disrupt mechanisms which perpetuate and sustain a problem in a given time and place	Moore and Evans (2017)
Program evaluation	Specific activities undertaken to make a positive difference in outcomes	Mayne (2015)

      2.1.3 Programs

Programs, complex interventions, and multicomponent interventions consist of multiple interventions that have been grouped into a package. The package is often designed to address: (1) a health problem that is conceptualized from different perspectives and experienced in different domains of health (e.g. cognitive and behavioral, as is the case with chronic insomnia); (2) a health problem that is attributable to a range of determinants occurring in different domains of health (e.g. physical, psychological, social) and at different levels (e.g. individual, community, healthcare system); or (3) co‐occurring and inter‐related health problems (e.g. comorbidity or multi‐morbidity that is, the presence of multiple acute and chronic conditions among older adults). Examples of programs are provided in Table 2.2.

2.2 INTERVENTION ELEMENTS

      Interventions are described in terms of the goals they are set to achieve and the components comprising them.

      2.2.1 Intervention Goals

      Interventions are designed to attain one or more goals related to a particular health problem. An intervention goal is a statement of what exactly the intervention is expected to achieve relative to the health problem it targets. Some interventions aim to modify the determinants or causes of the health problem and, hence, to prevent its occurrence. For example, changing a nonambulatory client's position in bed every two hours aims to prevent pressure ulcer, and instructing clients with asthma to avoid irritants such as dust and smoke is directed at preventing dyspnea. Other interventions are designed to manage the health problem, to reduce its burden, and/or to mitigate its negative consequences. For instance, taking a medication is useful in self‐managing muscle pain whereas listening to music is helpful in reducing the emotional reactions to pain such as anxiety (i.e. its burden); both interventions relieve pain and minimize its contribution to limited physical functioning (i.e. its negative consequences). Other interventions are directed at promoting engagement in health‐related behaviors such as physical activity and smoking cessation and consequently, enhancing general health and well‐being.

      2.2.2 Intervention Components

Interventions are comprised of one or more components. A component is a set of activities or techniques that are directed toward addressing a common goal. For example, the multicomponent intervention for insomnia described in Table 2.2 consists of four components, each addressing one goal: (1) sleep education and hygiene aims to help clients understand the factors that perpetuate insomnia, and the general behavioral and environmental recommendations to promote a good night's sleep; (2) stimulus control therapy focuses on reassociating the bed with sleep; (3) sleep restriction therapy aims to consolidate sleep; and (4)