ACTIVE INGREDIENTS
4.2.3 Experiential approach .1 Overview
4.2 Approaches for Delineating the Intervention’s Active Ingredients
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and to select the components that are most effective in addressing the potentially modifiable aspects of the health problem; (3) there is growing acknowledgement of publication bias, which threatens the validity of the synthesized empirical evidence;
that is, there is a tendency to selectively report positive outcomes (Chan et al., 2014) and publish reports of studies with “statistically significant” effects; when averaged, these effects yield overestimated intervention’s effects (van Assen et al., 2015).
The application of the theoretical and empirical approaches requires the avail- ability of relevant theory and theory-based therapies or techniques, and evidence respectively. In situations where theory and evidence are not accessible, the experien- tial approach is advocated, whereas in situations where theory has not been tested and evidence has not been generated from studies involving the client population and the context of interest, the combined approach is recommended.
4.2.3 Experiential approach
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The experts are selected to represent various subgroups of the respective cate- gories. For health professionals, the subgroups are defined by their professional affiliation and the types of services they provide. For the target client population, the subgroups are defined by their experience of the problem and its determinants, as well as sociodemographic, cultural, and health or clinical characteristics (Leask et al., 2019). For community leaders, the subgroups reflect a range of positions, such as representatives of specific client associa- tions, media or religious figures, and local or national government officials with a track record of advocacy to mobilize resources to address the health problem as experienced by the target client population.•
The number of experts to include in each meeting ranges from 6 to 12. This number is manageable and enables meaningful participation and high-quality discussion by all group members (Leask et al., 2019).•
The meetings are held in locations that are easily accessible to the experts, and in rooms, with seating that is comfortable (particularly if the experts include clients with physical challenges) and promotes group communication and interaction.•
The meetings may extend over a few hours (e.g. Johnson et al., 2017) or one day (e.g. Meng et al., 2019), necessitating the accommodation for breaks and refreshments.•
It is advisable to have facilitators with a particular set of qualifications. The facilitators have to be familiar with group processes; capable of engaging all participants in the discussion and of managing conflict that may arise;respectful of creative ideas (Clark, 2015); experienced in the application of the planned group exercises; and knowledgeable of the health problem as experi- enced by the client population.
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The meeting proceeds following the steps described in Table 4.2.Content analysis of the transcribed group discussion is geared toward the development of a map that identifies the collectively agreed upon techniques for addressing potentially modifiable aspects of the problem and achieving the desired changes. The map generated in different group meetings, held either for the same or different categories of experts, are compared and contrasted to identify commu- nalities or convergence in the proposed techniques; common techniques form a solid ground for delineating the intervention’s active ingredients. Discrepancies can be discussed and reconciled in meetings with groups of experts who expressed different views.
The group meetings have been applied in different situations. These include the last step of the concept mapping process as illustrated in Kelly et al. (2007); a modi- fied version of intervention mapping as done by Meng et al. (2019); and intervention co-design workshop described by Newby et al. (2019).
4.2.3.3 Strengths
The advantages of the experiential approach relate to the involvement of different experts, most notably clients, in the delineation of intervention active ingredients or techniques to address malleable aspects of the problem perceived as most relevant and salient to the client population and context of interest. As such, the intervention ingredients or techniques are consistent with the beliefs and values of the target client population and feasible within the clients’ context (Hawkins et al., 2017).
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This consistency among problem and techniques is likely to enhance the acceptabil- ity of the intervention (Leask et al., 2019). Accordingly, the experiential approach is highly valuable in designing interventions that are relevant to clients of different ethnic or cultural backgrounds. The resulting interventions are perceived as desir- able or acceptable. Acceptability enhances the uptake, engagement, adherence, and satisfaction with treatment and, hence, achievement of beneficial outcomes as dis- cussed in Chapter 11 (Araújo-Soares et al., 2018; Kildea et al., 2019; Smith et al., 2017).
4.2.3.4 Limitations
The application of the experiential approach has some drawbacks. It may be time con- suming to find participants who represent all subgroups of expertise and who are motivated and able to attend long meetings (Wamsler, 2017). Those who participate TABLE 4.2 Experiential approach: steps for conducting group meeting
with experts.
Step Activities
Step 1 Clarify the tasks at hand, which are to learn about experts or participants’
views of the health problem and ideas of ways to address it
Step 2 Describe the health problem of interest, using simple terms that are easy to grasp by experts with different levels of literacy. The description involves depiction of what the problem is
Step 3 Engage experts in group discussion of:
1. How the problem is experienced—to identify the range of possible indicators
2. What factors, occurring at what (e.g. individual and/or contextual) levels, contribute to the problem as experienced by the target client population—to identify most relevant ones
3. How the factors contribute to the problem—to clarify experts’
understanding of the interrelationships among determinants and the pathway linking determinants to the problem
Step 4 Involve experts in the identification of aspects of the problem they view as potentially modifiable, and of those, the aspects they consider most important requiring remediation
Step 5 Facilitate a group brainstorming exercise during which experts are encouraged to:
1. Specify desired changes
2. Share ideas about ways or techniques to address each aspect of the problem and to achieve the respective changes
Examples of questions to facilitate this exercise are:
For this particular determinant, what changes should take place?
What can done to make these changes?
What solutions or techniques are you aware of or have you used to address this determinant?
Additional questions are used to probe for clarification of proposed solutions/techniques and their perceived appropriateness and utility in inducing the desired changes
Step 6 Have the experts review the list of proposed solutions/techniquess, determine the ones that are relevant to various subgroups of the target client population and feasible within the context of interest, and reach an agreement on the ones to be selected for integration in the intervention
may represent select subgroups (e.g. clients who are articulate or experience the problem at a low level of severity), which can potentially limit the acceptability and applicability of the intervention.