The Csm A Conceptual Tool for Generating Interventions

Four issues must be considered when using the CSM to design interventions. First, there are many ways to get from an educational/behavioral input to behavioral outcomes that impact objective biological markers. Second, clinical trials differ from experiments: experiments target specific pathways. On the other hand, the typical trial involves a complex "package" that differentiates the intervention arm from the control arm. Even when a single agent is involved (e.g., a drug or blood glucose monitor), there is typically more than one pathway in the system from input to output. Third, the essential ingredient for success will differ across individuals. Some participants may need to revise their illness representations (e.g., revising their view of the cause of their disease), others may need to change their behavior for controlling outcomes (e.g., learning to use an inhaler), still others may need to change the targets for assessing outcomes (e.g., using a glucometer). We would not compare the efficacy of antibiotics between patients with bacterial or viral conditions. Nor should we compare the efficacy of behavioral interventions for individuals for whom they are irrelevant. Fourth, and perhaps most importantly, interventions often face the challenging and intriguing task of reframing recipients' perceptions. Reframing involves the following steps: (1) identifying the experiences (symptoms - presence or absence; functional and/or affective changes; observed similarities to others) that match an underlying prototype that support the individual's active representation

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