Nursing and Health Interventions. Souraya Sidani

components comprising the intervention can be provided simultaneously or sequentially. Simultaneous provision implies that the components and respective activities are presented, discussed, and carried out all together at one point in time. For instance, Sidani et al. (2019) designed the multicomponent intervention for chronic insomnia in a way whereby the information and recommendations of the sleep education and hygiene, stimulus control therapy, and sleep restriction therapy were conveyed to clients in the first intervention session; clients were instructed to apply all recommendations associated with these three components simultaneously.

Sequential provision means that the intervention components are given progressively, that is, one component is introduced at a time. This is illustrated with how Holmqvist et al. (2014) designed and delivered the cognitive behavioral therapy for insomnia: Clients were exposed to the therapy's components in the following sequence: (1) psychoeducation about sleep and models or factors contributing to insomnia; (2) relaxation training; (3) concepts of stimulus control therapy and sleep restriction therapy; (4) cognitive therapy; (5) information on sleep hygiene and stimulus control; and (6) mindfulness meditation.

      2.3.3 Dose

      Dose (also called intensity) refers to the level at which the intervention as‐a‐whole (i.e. including all its components) is delivered in order to effectively address the health problem and produce beneficial changes in other outcomes. Similar to the dose of medications, the dose of health interventions is operationalized in four aspects: purity, amount, frequency, and duration.

      Purity reflects the concentration of the active ingredients of the intervention; it can be quantified as the ratio of specific to nonspecific elements constituting the intervention. Amount, frequency, and duration reflect exposure to the intervention. Specifically, amount refers to the quantity with which the intervention is given. Quantity is represented by the number of contacts (e.g. individual or group sessions, home visits) planned with the health professional or laypersons responsible for delivering the intervention; or the number of modules (e.g. sections in a paper or electronic booklet) to be completed by clients. Quantity also quantifies the time it takes to complete each contact (e.g. length of a group session) or module (e.g. length of time to read the information presented in each section of the booklet).

      Frequency is the number of times the contacts are given or the modules are self‐completed, over a specified period of time such as a week or month. Duration is the total length of time during which the intervention is given. Amount, frequency, and duration are commonly reported to specify the dose of health interventions (Beall et al., 2014). For instance, the dose of the multicomponent intervention for insomnia can be specified as: four group sessions of 60 minutes each and two individual telephone contacts of 20 minutes each, for a total of six contacts (amount). The six contacts are given once a week (frequency), over a six‐week period (duration).

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SECTION II DEVELOPING INTERVENTIONS

CHAPTER 3 Understanding Health Problems

      Poorly designed interventions can waste resources (Moore et al., 2019): Despite the effort expanded by health professionals and clients in carrying them out, the interventions are not useful in preventing, managing, or resolving the health problem. Therefore, it is essential to carefully design health interventions in order to improve their success in addressing the