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Background: Measurement of intervention fidelity is an essential component of any scientifically sound intervention trial. However, few papers have proposed ways to integrate intervention fidelity data into the execution of these trials. Objective: The purpose of this article is to describe the intervention fidelity process used in a randomized controlled trial of a human patient simulator intervention and how these data were used to monitor drift and provide feedback to improve the consistency of both intervention and control delivery over time in a multisite education intervention for parents of children with newly diagnosed Type 1 diabetes. Methods: Intervention fidelity was measured for both the intervention and control condition by direct observation, self-report of interventionist delivery, and parent participant receipt of educational information. Intervention fidelity data were analyzed after 50%, 75%, and 100% of the participants had been recruited and compared by group (treatment and control) and research site. Results: The sample included 191 parents of young children newly diagnosed with Type 1 diabetes. Observations scores in both intervention and control groups indicated a high level of intervention fidelity. Treatment receipt was also high and did not differ by treatment group. The teaching session attendance rates by site and session were significantly different at Time Point 1 (50% enrollment); following study staff retraining and reinforcement, there were no significant differences at Time Point 3 (100% enrollment). Implications: Results demonstrate the importance of monitoring intervention fidelity in both the intervention and control condition over time and using these data to correct drift during the course of a multisite clinical trial.

In this paper we review the skills that have been found to be related to good story comprehension in novice readers with normal hearing, and describe the relative weight each plays in good story comprehension. The relationship between effective story comprehension and lower-level skills (such as syntactic awareness and vocabulary knowledge) is considered, and the casual relations between discourse-level skills (such as inference abilities and story structure understanding) and good text comprehension are delineated. We then compare this information to what is known about the abilities of children who are deaf or hard-of-hearing (DHH), and review the current research findings concerned with text intervention strategies designed for this population. Drawing on research both with hearing and DHH readers, we make suggestions for future text intervention strategies and research for DHH readers, which emphasize the need for research on practices that are directed (at least in part) at training the discourse-level component skills involved in effective story comprehension.

Purpose To describe fathers' experiences in parenting and managing the care of their young children with type 1 diabetes. Design and methods This qualitative descriptive study used 16 open-ended, in-depth interviews with 14 purposively selected, involved, educated, stably employed fathers of 15 children younger than 10 years old. The fathers were asked to describe their perspective of the initial diagnosis, how they learned diabetes care, their day-to-day care and parenting experiences, and what strategies they used in the day-to-day management. Data were managed using NVivo software and analyzed using principles of naturalistic inquiry and qualitative content analysis. Results The overarching theme was "From sadness to action," with six categories emerging: (1) "shock and awe" (after diagnosis), (2) quick response to the diagnosis and learning diabetes care: "suck it up and do it," (3) "staying in the loop" (practicing the skills, tasks, and responsibilities of diabetes management), (4) "partnerships in care" (tag teaming or co-parenting), (5) active participation (being actively involved in their children's day-to-day care and benefiting from participating in this care), and (6) mantra for living with diabetes: child first, diabetes second. Clinical implications Nurses working with children with diabetes can use the results of this study to better understand the role of fathers in the care of these children. Fathers underscored the importance of practicing diabetes care-related tasks to improve their confidence when caring for children alone. Their practical and philosophical strategies for managing their children's chronic illness have recently been incorporated into a parent mentor intervention for children newly diagnosed with type 1 diabetes.

Purpose To describe the process that mothers raising young (0-4 years old) children who are newly diagnosed with type 1 diabetes move through to attain the necessary skills to care for their children. Study design and methods A mixed methods design was used, including qualitative interviews with 28 mothers of young children with type 1 diabetes. Principles of naturalistic inquiry were used to guide the data collection process, management, and analysis of the qualitative findings. Results The process paralleled two of three management approaches and associated behaviors previously described by Gallo and Knafl. Strict adherence behaviors included rigidly following the team recommendations and avoiding strange environments outside the home. Flexible adherence behaviors strove to bring spontaneity back into family life. Selective adherence was not used by this population. Clinical implications Nurses working with these mothers can provide information and support to help them transition from using strict adherence to the more user-friendly flexible adherence, while avoiding the pitfalls of the possibly harmful third approach of selective adherence. Nurses need to remember to praise the parents' efforts at managing their children's diabetes, for our acknowledgment of their work is empowering and affirming.