SCALE DEVELOPMENT OF A MEASURE TO ASSESS COMMUNITY-BASED AND CLINICAL INTERVENTION GROUP ENVIRONMENTS.

Group interventions have been proposed as perhaps the most promising psychosocial treatment modality for persons receiving care in clinical and community-based health care settings (Simonton & Sherman, 2000), and interest in and practice of group interventions is growing among researchers and practitioners (Sherman et al., 2004). For the purposes of this study, group interventions refer to the broad range of behavioral and mental health interventions that are delivered within the group environment. Types of groups that fall under the umbrella of a “group intervention” include psychotherapeutic groups, educational groups, support groups, skills-building groups, and any combination of the four. Using this perspective, group interventions may take place as a part of a research study examining the effectiveness of an intervention (e.g., a randomized controlled clinical trial), or they can exist as a part of services provided to clients in public or private health service organizations or community-based organizations. Likewise, intervention groups refer to groups that are unstructured and conducted for indefinite periods of time, as well as those that are structured and delivered for a predetermined number of sessions to a fixed number of participants. There are many advantages of using the group environment to deliver an intervention. These advantages include: (a) the development of a sense of universality, cohesion, and social support among group members; (b) the opportunity for modeling and social learning from other group members, and (c) the positive experience of sharing with and helping others (Burlingame, MacKenzie, & Strauss, 2003; Hyde, Appleby, Weiss, Bailey & Morgan, 2005; Yalom, 1985). Additionally, research suggests that participants often view group interventions as less stigmatizing than individual interventions (Sherman et al., 2004). Furthermore, group interventions have been shown to be effective (Burlingame, Fuhriman, & Mosier, 2003), are more cost-effective than individual-level interventions (Holtgrave & Pinkerton, 1998) and allow for fewer personnel and reduced implementation-related costs. These features may make group interventions more desirable and practical for clinical and community-based prevention and treatment programs. While research has made clear the import of the group intervention as an integral part of behavioral and mental health interventions (Burlingame, MacKenzie, & Strauss, 2003; Hyde et al., 2005; Sherman et al., 2004), the social environment of the group, as well as relationships among group members and leaders (i.e., facilitators, therapists, or other personnel in charge of running and organizing the group) remain relatively undocumented in intervention research. Nonetheless, the perceived social environment of a group can exert a considerable influence on an intervention’s efficacy in reaching its designated goals and may help explain variation in behavioral and mental health outcomes among individual members of groups. Seminal research by Barker (1968, 1978) extensively documented the role that social settings play in influencing behavior and psychological well-being. Barker theorized that established standing patterns of behavior guide and shape interactions between persons within a setting, as well as learning and other psychological processes. Extending his theory to group interventions, one could posit that the group environment plays an important role in shaping the outcomes that interventions seek to change. Yalom (1985) echoed this idea in his work examining group psychotherapy. He noted that group cohesiveness, broadly defined as the participant’s relationship to the group leader, the other group members, and the group as a whole, is a strong determinant of positive therapeutic outcomes. Several studies have demonstrated that features of group environments have an impact on the effectiveness of interventions. In one study, examining members’ appraisals of self-help groups (i.e., Multiple Sclerosis, Compassionate Friends, and Overeaters Anonymous groups), members who perceived that their group was well organized and had a proficient leader reported greater satisfaction with the group, higher levels of selfγesteem, and lower levels of depression (Maton, 1988). Similar findings have been obtained in other studies, which have shown that primary group outcomes are related to several features of group environments, including perceived levels of group cohesion (Budman, Soldz, Demby, Feldstein, Springer & Davis, 1989; Meredith, 1987), disruptive group dynamics (Faris & Brown, 2003), group leadership and implementation (Kulic, Horne, & Dagley, 2004), and perceived group climate (Choi, Price, & Vinokur, 2003; MacKenzie, Dies, Coche, Rutan, & Stone, 1987).