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Westland H, Trappenburg JCA, Schuurmans MJ, Zonneveld MH, Schröder CD. Fidelity of primary care nurses' delivery of a behavioural change intervention enhancing physical activity in patients at risk of cardiovascular disease: an observational study. BMJ Open 2021; 11:e046551. [PMID: 33757957 PMCID: PMC7993355 DOI: 10.1136/bmjopen-2020-046551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate the fidelity of delivery of a nurse-led intervention to enhance physical activity in patients at risk for cardiovascular diseases, the Activate intervention, by assessing: (1) self-reported fidelity of delivery; (2) observed fidelity of delivery; (3) quality of delivery of the Activate intervention and (4) nurses' beliefs about their capability, motivation, confidence and effectiveness towards delivering the Activate intervention, including behavioural change techniques. DESIGN An observational study. SETTING General practices in the Netherlands. PARTICIPANTS Primary care nurses (n=20) from 16 general practices. PRIMARY AND SECONDARY OUTCOME MEASURES Nurses' self-reported fidelity was evaluated using checklists (n=282), and the observed fidelity and quality of delivery were examined using audiorecordings of consultations of the delivery of the Activate intervention (n=42). Nurses' beliefs towards delivering the intervention were assessed using questionnaires (n=72). RESULTS The self-reported fidelity was 88.1% and observed fidelity was 85.4%, representing high fidelity. The observed fidelity of applied behavioural change techniques was moderate (75.0%). The observed quality of delivery was sufficient and varied among nurses (mean 2.9; SD 4.4; range 0-4). Nurses' beliefs about their capability, motivation, confidence and effectiveness towards delivering the intervention increased over time. CONCLUSIONS Nurses delivered most intervention components as intended with sufficient quality. Nurses believed they were capable, motivated and confident to deliver the intervention. They believed the intervention was effective to increase patients' physical activity level. Despite the high fidelity and moderate fidelity of applied behavioural change techniques, the varying quality of delivery within and across nurses might have diluted the effectiveness of the Activate intervention. TRIAL REGISTRATION NUMBER NCT02725203.
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Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Jaap C A Trappenburg
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | | | - Michelle H Zonneveld
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Carin D Schröder
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht, Utrecht, The Netherlands
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Toomey E, Matvienko-Sikar K, Heary C, Delaney L, Queally M, Hayes CB, Kearney PM, Byrne M. Intervention Fidelity Within Trials of Infant Feeding Behavioral Interventions to Prevent Childhood Obesity: A Systematic Review. Ann Behav Med 2020; 53:75-97. [PMID: 29796664 DOI: 10.1093/abm/kay021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Intervention fidelity refers to whether an intervention has been implemented as intended. Trials of infant feeding behavioral interventions to prevent childhood obesity show inconsistent evidence of effectiveness. However, intervention fidelity has not been previously explored within these trials, limiting interpretation of findings. Purpose To review the use and/or reporting of strategies to enhance and assess intervention fidelity within trials of infant feeding interventions to prevent childhood obesity, and their association with study quality, effectiveness, and publication year. Methods Seven electronic databases were searched, with articles screened for inclusion by two reviewers. The National Institutes of Health Behaviour Change Consortium fidelity checklist was used to assess use and/or reporting of fidelity strategies across five domains (design, provider training, delivery, receipt, and enactment). Results Ten trials (16 papers) were identified. Average use/reporting of fidelity strategies was moderate (54%), ranging from 28.9% to 76.7%. Levels of use/reporting ranged from 15.9% in the domain of provider training to 95% for enactment. No association was found between these levels and study quality, effectiveness, or publication year. Conclusions The moderate use/reporting of fidelity strategies within trials of infant feeding interventions suggests that previous findings of inconsistent effectiveness may not fully reflect the intended interventions. The review highlights key considerations for improving future research, both in the area of behavioral infant feeding and wider behavior change literature. This includes improving reporting across all fidelity domains and ensuring an enhanced focus on provider training and control group content to optimize the translation of research into practice. PROSPERO Registration number CRD42016033492.
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Affiliation(s)
- Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Room 2058, Arts Millennium Building, Galway, Ireland
| | | | - Caroline Heary
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Lisa Delaney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Michelle Queally
- Discipline of Economics, JE Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | | | | | - Molly Byrne
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Gossage-Worrall R, Hind D, Barnard-Kelly KD, Shiers D, Etherington A, Swaby L, Holt RIG. STructured lifestyle education for people WIth SchizophrEnia (STEPWISE): mixed methods process evaluation of a group-based lifestyle education programme to support weight loss in people with schizophrenia. BMC Psychiatry 2019; 19:358. [PMID: 31722694 PMCID: PMC6854755 DOI: 10.1186/s12888-019-2282-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND STEPWISE is a theory-informed self-management education programme that was co-produced with service users, healthcare professionals and interventionists to support weight loss for people with schizophrenia. We report the process evaluation to inform understanding about the intervention and its effectiveness in a randomised controlled trial (RCT) that evaluated its efficacy. METHODS Following the UK Medical Research Council (MRC) Guidelines for developing and evaluating complex interventions, we explored implementation quality. We considered causal mechanisms, unanticipated consequences and contextual factors associated with variation in actual and intended outcomes, and integrated treatment fidelity, using the programme theory and a pipeline logic model. We followed a modified version of Linnan and Steckler's framework and single case design. Qualitative data from semi-structured telephone interviews with service-users (n = 24), healthcare professionals delivering the intervention (n = 20) and interventionists (n = 7) were triangulated with quantitative process and RCT outcome data and with observations by interventionists, to examine convergence within logic model components. RESULTS Training and course materials were available although lacked co-ordination in some trusts. Healthcare professionals gained knowledge and some contemplated changing their practice to reflect the (facilitative) 'style' of delivery. They were often responsible for administrative activities increasing the burden of delivery. Healthcare professionals recognised the need to address antipsychotic-induced weight gain and reported potential value from the intervention (subject to the RCT results). However, some doubted senior management commitment and sustainability post-trial. Service-users found the intervention highly acceptable, especially being in a group of people with similar experiences. Service-users perceived weight loss and lifestyle benefits; however, session attendance varied with 23% (n = 47) attending all group-sessions and 17% (n = 36) attending none. Service-users who lost weight wanted closer monitoring and many healthcare professionals wanted to monitor outcomes (e.g. weight) but it was outside the intervention design. No clinical or cost benefit was demonstrated from the intermediate outcomes (RCT) and any changes in RCT outcomes were not due to the intervention. CONCLUSIONS This process evaluation provides a greater understanding of why STEPWISE was unsuccessful in promoting weight loss during the clinical trial. Further research is required to evaluate whether different levels of contact and objective monitoring can support people with schizophrenia to lose weight. TRIAL REGISTRATION ISRCTN, ISRCTN19447796. Registered 20 March 2014.
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Affiliation(s)
- Rebecca Gossage-Worrall
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Daniel Hind
- 0000 0004 1936 9262grid.11835.3eClinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Katharine D. Barnard-Kelly
- 0000 0001 0728 4630grid.17236.31Faculty of Health & Social Science, Bournemouth University, Poole, Dorset, UK
| | - David Shiers
- 0000000121662407grid.5379.8Honorary Research Consultant, Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust and Honorary Reader in Early Psychosis, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Angela Etherington
- Patient Representative, Independent Service User Consultant, Manchester, UK
| | - Lizzie Swaby
- 0000 0004 1936 9262grid.11835.3eClinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Richard I. G. Holt
- 0000 0004 1936 9297grid.5491.9Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK ,grid.430506.4University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Holt RI, Hind D, Gossage-Worrall R, Bradburn MJ, Saxon D, McCrone P, Morris TA, Etherington A, Shiers D, Barnard K, Swaby L, Edwardson C, Carey ME, Davies MJ, Dickens CM, Doherty Y, French P, Greenwood KE, Kalidindi S, Khunti K, Laugharne R, Pendlebury J, Rathod S, Siddiqi N, Wright S, Waller G, Gaughran F, Barnett J, Northern A. Structured lifestyle education to support weight loss for people with schizophrenia, schizoaffective disorder and first episode psychosis: the STEPWISE RCT. Health Technol Assess 2019; 22:1-160. [PMID: 30499443 DOI: 10.3310/hta22650] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Obesity is twice as common in people with schizophrenia as in the general population. The National Institute for Health and Care Excellence guidance recommends that people with psychosis or schizophrenia, especially those taking antipsychotics, be offered a healthy eating and physical activity programme by their mental health care provider. There is insufficient evidence to inform how these lifestyle services should be commissioned. OBJECTIVES To develop a lifestyle intervention for people with first episode psychosis or schizophrenia and to evaluate its clinical effectiveness, cost-effectiveness, delivery and acceptability. DESIGN A two-arm, analyst-blind, parallel-group, randomised controlled trial, with a 1 : 1 allocation ratio, using web-based randomisation; a mixed-methods process evaluation, including qualitative case study methods and logic modelling; and a cost-utility analysis. SETTING Ten community mental health trusts in England. PARTICIPANTS People with first episode psychosis, schizophrenia or schizoaffective disorder. INTERVENTIONS Intervention group: (1) four 2.5-hour group-based structured lifestyle self-management education sessions, 1 week apart; (2) multimodal fortnightly support contacts; (3) three 2.5-hour group booster sessions at 3-monthly intervals, post core sessions. Control group: usual care assessed through a longitudinal survey. All participants received standard written lifestyle information. MAIN OUTCOME MEASURES The primary outcome was change in weight (kg) at 12 months post randomisation. The key secondary outcomes measured at 3 and 12 months included self-reported nutrition (measured with the Dietary Instrument for Nutrition Education questionnaire), objectively measured physical activity measured by accelerometry [GENEActiv (Activinsights, Kimbolton, UK)], biomedical measures, adverse events, patient-reported outcome measures and a health economic assessment. RESULTS The trial recruited 414 participants (intervention arm: 208 participants; usual care: 206 participants) between 10 March 2015 and 31 March 2016. A total of 341 participants (81.6%) completed the trial. A total of 412 participants were analysed. After 12 months, weight change did not differ between the groups (mean difference 0.0 kg, 95% confidence interval -1.59 to 1.67 kg; p = 0.964); physical activity, dietary intake and biochemical measures were unchanged. Glycated haemoglobin, fasting glucose and lipid profile were unchanged by the intervention. Quality of life, psychiatric symptoms and illness perception did not change during the trial. There were three deaths, but none was related to the intervention. Most adverse events were expected and related to the psychiatric illness. The process evaluation showed that the intervention was acceptable, with participants valuing the opportunity to interact with others facing similar challenges. Session feedback indicated that 87.2% of participants agreed that the sessions had met their needs. Some indicated the desire for more ongoing support. Professionals felt that the intervention was under-resourced and questioned the long-term sustainability within current NHS settings. Professionals would have preferred greater access to participants' behaviour data to tailor the intervention better. The incremental cost-effectiveness ratio from the health-care perspective is £246,921 per quality-adjusted life-year (QALY) gained and the incremental cost-effectiveness ratio from the societal perspective is £367,543 per QALY gained. CONCLUSIONS Despite the challenges of undertaking clinical research in this population, the trial successfully recruited and retained participants, indicating a high level of interest in weight management interventions; however, the STEPWISE intervention was neither clinically effective nor cost-effective. Further research will be required to define how overweight and obesity in people with schizophrenia should be managed. The trial results suggest that lifestyle programmes for people with schizophrenia may need greater resourcing than for other populations, and interventions that have been shown to be effective in other populations, such as people with diabetes mellitus, are not necessarily effective in people with schizophrenia. TRIAL REGISTRATION Current Controlled Trials ISRCTN19447796. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 65. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Richard Ig Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | | | - David Saxon
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tiyi A Morris
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Katharine Barnard
- Faculty of Health & Social Sciences, Bournemouth University, Poole, UK
| | - Lizzie Swaby
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Marian E Carey
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Yvonne Doherty
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK.,Psychological Medicine, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kathryn E Greenwood
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Sridevi Kalidindi
- Rehabilitation and Recovery, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Richard Laugharne
- Research and Innovation, Cornwall Partnership NHS Foundation Trust, Redruth, UK
| | | | - Shanaya Rathod
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Najma Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York, UK.,Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Stephen Wright
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Glenn Waller
- Sheffield Health & Social Care NHS Foundation Trust, Sheffield, UK.,Department of Psychology, University of Sheffield, Sheffield, UK
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Psychosis Unit and Research and Development Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Janette Barnett
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Alison Northern
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
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Gainforth HL, Lorencatto F, Erickson K, Baxter K, Owens K, Michie S, West R. Use of dynamic systems methods to characterize dyadic interactions in smoking cessation behavioural support sessions: A feasibility study. Br J Health Psychol 2018; 24:192-214. [PMID: 30489001 DOI: 10.1111/bjhp.12347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 10/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding how behaviour change techniques (BCTs) operate in practice requires a method for characterizing the reciprocal, dynamic, and real-time nature of behavioural support interactions between practitioners and clients. State space grids (SSGs) are an observational, dynamic systems methodology used to map the trajectory of dyadic interactions in real time. By mapping the flow of events in terms of practitioner and client actions, SSGs are potentially well suited to characterize behavioural support sessions. PURPOSE To develop reliable methods and examine the feasibility of using the SSG methodology for characterizing practitioners' delivery of and clients' response to BCTs in smoking cessation behavioural support sessions. METHODS Smoking cessation behavioural support sessions were video-recorded and transcribed verbatim (n = 6 recordings; 2,916 statements). All speech was coded independently by two researchers for content and duration using published frameworks for specifying practitioner-delivered and client-received BCTs in smoking cessation interactions. Inter-rater reliability was assessed. Indices of practitioner-client interaction dynamics were derived: (1) reciprocity (i.e., attractor states, content congruence, conditional pairing) and (2) temporal patterning (i.e., variability, inter-grid distance, combinatory micro-patterning, sessional macropatterning). The extent to which indices can describe differences between sessions involving different practitioners and clients was examined. RESULTS Inter-rater reliability was moderate at 72% agreement. Indices of reciprocity and temporal patterning characterized differences between sessions involving different practitioners and clients. CONCLUSIONS State space grids provide a method for characterizing the complexity and variability of practitioner-delivered and client-received BCTs in behavioural support sessions. This method has potential to add explanatory value to smoking cessation intervention outcomes. Statement of Contribution What is already known on this subject? Frameworks exist for characterizing practitioner-delivered and client-received behaviour change techniques (BCTs). Methods are still needed to investigate which BCTs are effective under what conditions. State space grids (SSGs) are a dynamic systems method that may better characterize behavioural support interactions. What does this study add? First reliable, dynamic systems, SSG coding procedures, methods, and measures to characterize behavioural support. A method for examining reciprocality and temporal patterning of BCT delivery and receipt. Establishes a dynamic systems method that adds explanatory value to the outcomes of interventions.
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Affiliation(s)
| | | | - Karl Erickson
- Michigan State University, East Lansing, Michigan, USA
| | - Kristy Baxter
- University of British Columbia, Kelowna, British Columbia, Canada
| | - Kailey Owens
- University of British Columbia, Kelowna, British Columbia, Canada
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Boisvert S, Proulx-Belhumeur A, Gonçalves N, Doré M, Francoeur J, Gallani MC. An integrative literature review on nursing interventions aimed at increasing self-care among heart failure patients. Rev Lat Am Enfermagem 2017; 23:753-68. [PMID: 26444179 PMCID: PMC4623739 DOI: 10.1590/0104-1169.0370.2612] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze and summarize knowledge concerning critical components of interventions that have been proposed and implemented by nurses with the aim of optimizing self-care by heart failure patients. METHODS PubMed and CINAHL were the electronic databases used to search full peer-reviewed papers, presenting descriptions of nursing interventions directed to patients or to patients and their families and designed to optimize self-care. Forty-two studies were included in the final sample (n=4,799 patients). RESULTS this review pointed to a variety and complexity of nursing interventions. As self-care encompasses several behaviors, interventions targeted an average of 3.6 behaviors. Educational/counselling activities were combined or not with cognitive behavioral strategies, but only about half of the studies used a theoretical background to guide interventions. Clinical assessment and management were frequently associated with self-care interventions, which varied in number of sessions (1 to 30); length of follow-up (2 weeks to 12 months) and endpoints. CONCLUSIONS these findings may be useful to inform nurses about further research in self-care interventions in order to propose the comparison of different modalities of intervention, the use of theoretical background and the establishment of endpoints to evaluate their effectiveness.
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Affiliation(s)
- Sophie Boisvert
- Faculté des sciences infirmières, Université Laval, Québec, QC, CA
| | | | - Natalia Gonçalves
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR
| | - Michel Doré
- Faculté des sciences infirmières, Université Laval, Québec, QC, CA
| | - Julie Francoeur
- Institut universitaire de cardiologie et pneumologie de Québec, Québec, QC, CA
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Toomey E, Matthews J, Hurley DA. Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain. BMJ Open 2017; 7:e015452. [PMID: 28780544 PMCID: PMC5724095 DOI: 10.1136/bmjopen-2016-015452] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES AND DESIGN Despite an increasing awareness of the importance of fidelity of delivery within complex behaviour change interventions, it is often poorly assessed. This mixed methods study aimed to establish the fidelity of delivery of a complex self-management intervention and explore the reasons for these findings using a convergent/triangulation design. SETTING Feasibility trial of the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) intervention (ISRCTN49875385), delivered in primary care physiotherapy. METHODS AND OUTCOMES 60 SOLAS sessions were delivered across seven sites by nine physiotherapists. Fidelity of delivery of prespecified intervention components was evaluated using (1) audio-recordings (n=60), direct observations (n=24) and self-report checklists (n=60) and (2) individual interviews with physiotherapists (n=9). Quantitatively, fidelity scores were calculated using percentage means and SD of components delivered. Associations between fidelity scores and physiotherapist variables were analysed using Spearman's correlations. Interviews were analysed using thematic analysis to explore potential reasons for fidelity scores. Integration of quantitative and qualitative data occurred at an interpretation level using triangulation. RESULTS Quantitatively, fidelity scores were high for all assessment methods; with self-report (92.7%) consistently higher than direct observations (82.7%) or audio-recordings (81.7%). There was significant variation between physiotherapists' individual scores (69.8% - 100%). Both qualitative and quantitative data (from physiotherapist variables) found that physiotherapists' knowledge (Spearman's association at p=0.003) and previous experience (p=0.008) were factors that influenced their fidelity. The qualitative data also postulated participant-level (eg, individual needs) and programme-level factors (eg, resources) as additional elements that influenced fidelity. CONCLUSION The intervention was delivered with high fidelity. This study contributes to the limited evidence regarding fidelity assessment methods within complex behaviour change interventions. The findings suggest a combination of quantitative methods is suitable for the assessment of fidelity of delivery. A mixed methods approach provided a more insightful understanding of fidelity and its influencing factors. TRIAL REGISTRATION NUMBER ISRCTN49875385; Pre-results.
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Affiliation(s)
- Elaine Toomey
- School of Psychology, Arts Millennium Building, National University of Ireland, Galway, Ireland
| | - James Matthews
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Belfield, Ireland
| | - Deirdre A Hurley
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Belfield, Ireland
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Lorencatto F, Gould NJ, McIntyre SA, During C, Bird J, Walwyn R, Cicero R, Glidewell L, Hartley S, Stanworth SJ, Foy R, Grimshaw JM, Michie S, Francis JJ. A multidimensional approach to assessing intervention fidelity in a process evaluation of audit and feedback interventions to reduce unnecessary blood transfusions: a study protocol. Implement Sci 2016; 11:163. [PMID: 27955683 PMCID: PMC5153878 DOI: 10.1186/s13012-016-0528-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background In England, NHS Blood and Transplant conducts national audits of transfusion and provides feedback to hospitals to promote evidence-based practice. Audits demonstrate 20% of transfusions fall outside guidelines. The AFFINITIE programme (Development & Evaluation of Audit and Feedback INterventions to Increase evidence-based Transfusion practIcE) involves two linked, 2×2 factorial, cluster-randomised trials, each evaluating two theoretically-enhanced audit and feedback interventions to reduce unnecessary blood transfusions in UK hospitals. The first intervention concerns the content/format of feedback reports. The second aims to support hospital transfusion staff to plan their response to feedback and includes a web-based toolkit and telephone support. Interpretation of trials is enhanced by comprehensively assessing intervention fidelity. However, reviews demonstrate fidelity evaluations are often limited, typically only assessing whether interventions were delivered as intended. This protocol presents methods for assessing fidelity across five dimensions proposed by the Behaviour Change Consortium fidelity framework, including intervention designer-, provider- and recipient-levels. Methods (1) Design: Intervention content will be specified in intervention manuals in terms of component behaviour change techniques (BCTs). Treatment differentiation will be examined by comparing BCTs across intervention/standard practice, noting the proportion of unique/convergent BCTs. (2) Training: draft feedback reports and audio-recorded role-play telephone support scenarios will be content analysed to assess intervention providers’ competence to deliver manual-specified BCTs. (3) Delivery: intervention materials (feedback reports, toolkit) and audio-recorded telephone support session transcripts will be content analysed to assess actual delivery of manual-specified BCTs during the intervention period. (4) Receipt and (5) enactment: questionnaires, semi-structured interviews based on the Theoretical Domains Framework, and objective web-analytics data (report downloads, toolkit usage patterns) will be analysed to assess hospital transfusion staff exposure to, understanding and enactment of the interventions, and to identify contextual barriers/enablers to implementation. Associations between observed fidelity and trial outcomes (% unnecessary transfusions) will be examined using mediation analyses. Discussion If the interventions have acceptable fidelity, then results of the AFFINITIE trials can be attributed to effectiveness, or lack of effectiveness, of the interventions. Hence, this comprehensive assessment of fidelity will be used to interpret trial findings. These methods may inform fidelity assessments in future trials. Trial registration ISRCTN 15490813. Registered 11/03/2015 Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0528-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fabiana Lorencatto
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, EC1V 0HB, UK.
| | - Natalie J Gould
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Stephen A McIntyre
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Camilla During
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Jon Bird
- School of Mathematics, Computer Science, Engineering, City, University of London, London, UK
| | - Rebecca Walwyn
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Robert Cicero
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Liz Glidewell
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Suzanne Hartley
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Simon J Stanworth
- National Health Service Blood & Transplant, Oxford Radcliffe Hospitals, University of Oxford, Oxford, UK
| | - Robbie Foy
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jeremy M Grimshaw
- Department of Medicine & Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Susan Michie
- Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Jill J Francis
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, EC1V 0HB, UK
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Duffy SA, Cummins SE, Fellows JL, Harrington KF, Kirby C, Rogers E, Scheuermann TS, Tindle HA, Waltje AH. Fidelity monitoring across the seven studies in the Consortium of Hospitals Advancing Research on Tobacco (CHART). Tob Induc Dis 2015; 13:29. [PMID: 26336372 PMCID: PMC4557818 DOI: 10.1186/s12971-015-0056-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This paper describes fidelity monitoring (treatment differentiation, training, delivery, receipt and enactment) across the seven National Institutes of Health-supported Consortium of Hospitals Advancing Research on Tobacco (CHART) studies. The objectives of the study were to describe approaches to monitoring fidelity including treatment differentiation (lack of crossover), provider training, provider delivery of treatment, patient receipt of treatment, and patient enactment (behavior) and provide examples of application of these principles. METHODS Conducted between 2010 and 2014 and collectively enrolling over 9500 inpatient cigarette smokers, the CHART studies tested different smoking cessation interventions (counseling, medications, and follow-up calls) shown to be efficacious in Cochrane Collaborative Reviews. The CHART studies compared their unique treatment arm(s) to usual care, used common core measures at baseline and 6-month follow-up, but varied in their approaches to monitoring the fidelity with which the interventions were implemented. RESULTS Treatment differentiation strategies included the use of a quasi-experimental design and monitoring of both the intervention and control group. Almost all of the studies had extensive training for personnel and used a checklist to monitor the intervention components, but the items on these checklists varied widely and were based on unique aspects of the interventions, US Public Health Service and Joint Commission smoking cessation standards, or counselor rapport. Delivery of medications ranged from 31 to 100 % across the studies, with higher levels from studies that gave away free medications and lower levels from studies that sought to obtain prescriptions for the patient in real world systems. Treatment delivery was highest among those studies that used automated (interactive voice response and website) systems, but this did not automatically translate into treatment receipt and enactment. Some studies measured treatment enactment in two ways (e.g., counselor or automated system report versus patient report) showing concurrence or discordance between the two measures. CONCLUSION While fidelity monitoring can be challenging especially in dissemination trials, the seven CHART studies used a variety of methods to enhance fidelity with consideration for feasibility and sustainability. TRIAL REGISTRATION Dissemination of Tobacco Tactics for hospitalized smokers. Clinical Trials Registration No. NCT01309217.Smoking cessation in hospitalized smokers. Clinical Trials Registration No. NCT01289275.Using "warm handoffs" to link hospitalized smokers with tobacco treatment after discharge: study protocol of a randomized controlled trial. Clinical Trials Registration No. NCT01305928.Web-based smoking cessation intervention that transitions from inpatient to outpatient. Clinical Trials Registration No. NCT01277250.Effectiveness of smoking-cessation interventions for urban hospital patients. Clinical Trials Registration No. NCT01363245.Comparative effectiveness of post-discharge interventions for hospitalized smokers. Clinical Trials Registration No. NCT01177176.Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals. Clinical Trials Registration No. NCT01236079.
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Affiliation(s)
- Sonia A. Duffy
- />Ohio State University, College of Nursing, Newton Hall, 1585 Neil Ave, Columbus, OH 43210 USA
- />VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI 48105 USA
| | - Sharon E. Cummins
- />Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, MC0905, La Jolla, CA 92093 USA
| | - Jeffrey L. Fellows
- />Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227 USA
| | - Kathleen F. Harrington
- />Division of Pulmonary Medicine, University of Alabama at Birmingham, 1900 University Blvd., THT541-G1, Birmingham, AL 35294-0006 USA
| | - Carrie Kirby
- />Moores Cancer Center, University of California, San Diego, 9500 Gilman Drive, MC0905, La Jolla, CA 92093 USA
| | - Erin Rogers
- />Department of Population Health, New York University School of Medicine, 227 E. 30th St., New York, NY & VA New York Harbor Healthcare System, 423 E. 23rd St., New York, NY USA
| | - Taneisha S. Scheuermann
- />Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
| | - Hilary A. Tindle
- />Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 370, Nashville, TN 37203 USA
| | - Andrea H. Waltje
- />University of Michigan, Internal Medicine, Brehm Tower, Room 6115, 1000 Wall Street, Ann Arbor, MI 48109-5714 USA
| | - the Consortium of Hospitals Advancing Research on Tobacco (CHART)
- />Ohio State University, College of Nursing, Newton Hall, 1585 Neil Ave, Columbus, OH 43210 USA
- />VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI 48105 USA
- />Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, MC0905, La Jolla, CA 92093 USA
- />Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227 USA
- />Division of Pulmonary Medicine, University of Alabama at Birmingham, 1900 University Blvd., THT541-G1, Birmingham, AL 35294-0006 USA
- />Moores Cancer Center, University of California, San Diego, 9500 Gilman Drive, MC0905, La Jolla, CA 92093 USA
- />Department of Population Health, New York University School of Medicine, 227 E. 30th St., New York, NY & VA New York Harbor Healthcare System, 423 E. 23rd St., New York, NY USA
- />Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
- />Department of Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 370, Nashville, TN 37203 USA
- />University of Michigan, Internal Medicine, Brehm Tower, Room 6115, 1000 Wall Street, Ann Arbor, MI 48109-5714 USA
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Roberts S, Desbrow B, Chaboyer W. Feasibility of a patient-centred nutrition intervention to improve oral intakes of patients at risk of pressure ulcer: a pilot randomised control trial. Scand J Caring Sci 2015; 30:271-80. [DOI: 10.1111/scs.12239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 03/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Shelley Roberts
- Griffith University School of Allied Health Sciences; Griffith University; Gold Coast Qld Australia
- Centre for Health Practice Innovation; Griffith University; Gold Coast Qld Australia
- Griffith Health Institute; Griffith University; Gold Coast Qld Australia
- NHMRC Centre of Research Excellence in Nursing; Griffith University; Gold Coast Qld Australia
| | - Ben Desbrow
- Griffith University School of Allied Health Sciences; Griffith University; Gold Coast Qld Australia
- Centre for Health Practice Innovation; Griffith University; Gold Coast Qld Australia
- Griffith Health Institute; Griffith University; Gold Coast Qld Australia
| | - Wendy Chaboyer
- Centre for Health Practice Innovation; Griffith University; Gold Coast Qld Australia
- Griffith Health Institute; Griffith University; Gold Coast Qld Australia
- NHMRC Centre of Research Excellence in Nursing; Griffith University; Gold Coast Qld Australia
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Brose LS, McEwen A, Michie S, West R, Chew XY, Lorencatto F. Treatment manuals, training and successful provision of stop smoking behavioural support. Behav Res Ther 2015; 71:34-9. [PMID: 26057438 DOI: 10.1016/j.brat.2015.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 05/15/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Translating evidence-based behaviour change interventions into practice is aided by use of treatment manuals specifying the recommended content and format of interventions, and evidence-based training. This study examined whether outcomes of stop smoking behavioural support differed with practitioner's use and evaluation of treatment manuals, or practitioner's training. METHODS English stop smoking practitioners were invited to complete an online survey including questions on: practitioners' training, availability, use and perceived utility of manuals, and annual biochemically-validated success rates of quit attempts supported (practitioner-reported). Mean success rates were compared between practitioners with/without access to manuals, those using/not using manuals, perceived utility ratings of manuals, and consecutive levels of training completed. RESULTS Success rates were higher if practitioners had a manual (Mean (SD) = 54.0 (24.0) versus 48.0 (25.3), t(838) = 2.48, p = 0.013; n = 840), used a manual (F(2,8237) = 4.78, p = 0.009, n = 840), perceived manuals as more useful (F(3,834) = 2.90, p = 0.034, n = 840), and had completed training (F(3,709) = 4.81, p = 0.002, n = 713). Differences were diminished when adjusting for professional and demographic characteristics and no longer reached statistical significance using a conventional alpha for perceived utility of manuals and training status (both p = 0.1). CONCLUSIONS Practitioners' performance in supporting smokers to quit varied with availability and use of treatment manuals. Evidence was weaker for perceived utility of manuals and practitioners' evidence-based training. Ensuring practitioners have access to treatment manuals within their service, promoting manual use, and training practitioners to competently apply manuals is likely to contribute to higher success rates in clinical practice.
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Affiliation(s)
- Leonie S Brose
- National Addictions Centre, UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Andy McEwen
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
| | - Susan Michie
- Centre for Outcomes Research and Effectiveness, University College London, London, UK.
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
| | - Xie Yin Chew
- Department of Psychology and Language Sciences, University College London, London, UK.
| | - Fabiana Lorencatto
- Health Services Research and Management, School of Health Sciences, City University London, London, UK.
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13
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Implementation fidelity of physiotherapist-delivered group education and exercise interventions to promote self-management in people with osteoarthritis and chronic low back pain: a rapid review part II. ACTA ACUST UNITED AC 2014; 20:287-94. [PMID: 25466294 DOI: 10.1016/j.math.2014.10.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 10/03/2014] [Accepted: 10/16/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Implementation fidelity is the extent to which an intervention is delivered as intended by intervention developers, and is extremely important as it increases confidence that changes in study outcomes are due to the effect of the intervention itself and not due to variability in implementation. A paucity of literature exists concerning implementation fidelity in physiotherapy research. DESIGN AND OBJECTIVES This rapid review aimed to evaluate the implementation fidelity of group-based self-management interventions for people with osteoarthritis (OA) and/or chronic low back pain (CLBP). METHOD Group-based self-management interventions delivered by health-care professionals (including at least one physiotherapist) involving adults with OA and/or CLBP were eligible for inclusion. The National Institutes of Health Behaviour Change Consortium Treatment Fidelity checklist was used to assess fidelity and applied independently by two reviewers. RESULTS In total, 22 studies were found. Fidelity was found to be very low (mean score 36%) within the included studies with only one study achieving >80% on the framework. The domain of Training of Providers achieved the lowest fidelity rating (10%) across all studies. CONCLUSIONS Overall levels of implementation fidelity are low in self-management interventions for CLBP and/or OA; however it is unclear whether fidelity is poor within the trials included in this review, or just poorly reported. There is a need for the development of fidelity reporting guidelines and for the refinement of fidelity frameworks upon which to base these guidelines.
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Lorencatto F, West R, Christopherson C, Michie S. Assessing fidelity of delivery of smoking cessation behavioural support in practice. Implement Sci 2013; 8:40. [PMID: 23557119 PMCID: PMC3622616 DOI: 10.1186/1748-5908-8-40] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 03/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effectiveness of evidence-based behaviour change interventions is likely to be undermined by failure to deliver interventions as planned. Behavioural support for smoking cessation can be a highly cost-effective, life-saving intervention. However, in practice, outcomes are highly variable. Part of this may be due to variability in fidelity of intervention implementation. To date, there have been no published studies on this. The present study aimed to: evaluate a method for assessing fidelity of behavioural support; assess fidelity of delivery in two English Stop-Smoking Services; and compare the extent of fidelity according to session types, duration, individual practitioners, and component behaviour change techniques (BCTs). METHODS Treatment manuals and transcripts of 34 audio-recorded behavioural support sessions were obtained from two Stop-Smoking Services and coded into component BCTs using a taxonomy of 43 BCTs. Inter-rater reliability was assessed using percentage agreement. Fidelity was assessed by examining the proportion of BCTs specified in the manuals that were delivered in individual sessions. This was assessed by session type (i.e., pre-quit, quit, post-quit), duration, individual practitioner, and BCT. RESULTS Inter-coder reliability was high (87.1%). On average, 66% of manual-specified BCTs were delivered per session (SD 15.3, range: 35% to 90%). In Service 1, average fidelity was highest for post-quit sessions (69%) and lowest for pre-quit (58%). In Service 2, fidelity was highest for quit-day (81%) and lowest for post-quit sessions (56%). Session duration was not significantly correlated with fidelity. Individual practitioner fidelity ranged from 55% to 78%. Individual manual-specified BCTs were delivered on average 63% of the time (SD 28.5, range: 0 to 100%). CONCLUSIONS The extent to which smoking cessation behavioural support is delivered as specified in treatment manuals can be reliably assessed using transcripts of audiotaped sessions. This allows the investigation of the implementation of evidence-based practice in relation to smoking cessation, a first step in designing interventions to improve it. There are grounds for believing that fidelity in the English Stop-Smoking Services may be low and that routine monitoring is warranted.
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Affiliation(s)
- Fabiana Lorencatto
- NHS Centre for Smoking Cessation and Training, Dept. Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
- Centre for Outcomes Research and Effectiveness, Dept. Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Robert West
- CRUK Health Behaviour Research Centre, Dept. Epidemiology & Public Health, University College London, London, WC1E 7HB, UK
| | | | - Susan Michie
- Centre for Outcomes Research and Effectiveness, Dept. Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
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Abstract
BACKGROUND Treatment fidelity, also called intervention fidelity, is an important component of testing treatment efficacy. Although examples of strategies needed to address treatment fidelity have been provided in several published reports, data describing variations that might compromise efficacy testing have been omitted. OBJECTIVES The aim of this study is to describe treatment fidelity monitoring strategies and data within the context of a nursing clinical trial. METHODS A three-group, randomized, controlled trial compared intervention (paced respiration) to attention control (fast, shallow breathing) to usual care for management of hot flashes and other menopausal symptoms. Data from both staff and participants were collected to assess treatment fidelity. RESULTS Staff measures for treatment delivery indicated good adherence to protocols. Participant ratings of expectancy and credibility were not statistically different between intervention and attention control; however, the attention control was significantly more acceptable (p < .05). Intervention participant data indicated good treatment receipt and enactment with mean breath rates at each time point falling within the target range. Practice log data for both intervention and attention control indicated lower adherence of once-daily rather than twice-daily practice. DISCUSSION Despite strengths in fidelity monitoring, some challenges were identified that have implications for other similar intervention studies.
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Abstract
PURPOSE Limited information on intervention fidelity is available in published studies with youth and families. The components of intervention fidelity, the complexity of measurement in these studies, and strategies for measuring intervention fidelity are described. CONCLUSIONS Strategies for ensuring intervention fidelity according to the Treatment Fidelity Workgroup of the Behavior Change Consortium in the areas of study design, provider training, treatment delivery, treatment receipt, and treatment enactment provide guidance for evaluating or developing intervention fidelity plans. PRACTICE IMPLICATIONS Ensuring the quality of intervention fidelity in evidence-based reviews or when developing new interventions is essential for translating findings into practice.
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Preyde M, Burnham PV. Intervention fidelity in psychosocial oncology. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2011; 8:379-396. [PMID: 21827305 DOI: 10.1080/15433714.2011.542334] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Intervention fidelity refers to strategies that practitioners and researchers use to monitor, enhance, or evaluate the accuracy and consistency of the delivery of an intervention to ensure that it is implemented according to how it was planned. The purpose of the authors in this article was to evaluate intervention fidelity in the psychosocial oncology intervention effectiveness research. Twenty-eight studies located in a previous systematic review on psychosocial oncology intervention effectiveness comprised the sample for this research. A treatment fidelity checklist was applied to each study independently by each author (MP & PB). Percent agreement between raters ranged from 68% to 100% (M = 89%). Overall, the mean proportion of adherence was 0.57 (SD 0.12), which may be considered to be moderate fidelity. Critical examination and applicability of the checklist in examining and assessing intervention fidelity were highlighted and discussed. Overall, intervention fidelity was adequately addressed in the psychosocial oncology intervention effectiveness research, and integrity was confirmed in the majority of studies reviewed. Suggestions for future psychosocial oncology effectiveness research were made.
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Affiliation(s)
- Michèle Preyde
- Department of Family Relations and Applied Nutrition, University of Guelph, Ontario, Canada.
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Borrelli B. The Assessment, Monitoring, and Enhancement of Treatment Fidelity In Public Health Clinical Trials. J Public Health Dent 2011; 71:S52-S63. [PMID: 21499543 DOI: 10.1111/j.1752-7325.2011.00233.x] [Citation(s) in RCA: 507] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES: To discuss methods of preservation of treatment fidelity in health behavior change trials conducted in public health contexts. METHODS: The treatment fidelity framework provided by the NIH's Behavioral Change Consortium (BCC) (1) includes five domains of treatment fidelity (Study Design, Training, Delivery, Receipt, and Enactment). A measure of treatment fidelity was previously developed and validated using these categories. RESULTS: Strategies for assessment, monitoring, and enhancing treatment fidelity within each of the five treatment fidelity domains are discussed. The previously created measure of treatment fidelity is updated to include additional items on selecting providers, additional confounders, theory testing, and multicultural considerations. CONCLUSIONS: Implementation of a treatment fidelity plan may require extra staff time and costs. However, the economic and scientific costs of lack of attention to treatment fidelity are far greater than the costs of treatment fidelity implementation. Maintaining high levels of treatment fidelity with flexible adaptation according to setting, provider, and patient is the goal for public health trials.
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Affiliation(s)
- Belinda Borrelli
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital; & Warren Alpert School of Medicine at Brown University, Providence, RI. USA
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Qiu Y, Xu H, Zhao DY. Therapeutic evaluation on complex interventions of integrative medicine and the potential role of data mining. Chin J Integr Med 2010; 16:466-71. [PMID: 20872122 DOI: 10.1007/s11655-010-0549-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Indexed: 10/19/2022]
Abstract
It is a common view that the integration of Chinese medicine (CM) and modern Western medicine is an efficient way to facilitate the development of CM. Integrative medicine is a kind of complex interventions. Scientific therapeutic evaluation plays a crucial role in making integrative medicine universally acknowledged. However, the modern method of clinical study, which is based on the concept of evidence-based medicine, mostly focuses on the population characteristics and single interventional factor. As a result, it is difficult for this method to totally adapt to the clinical features of CM and integrative medicine as complex interventions. One possible way to solve this issue is to improve and integrate with the existing method and to utilize the evaluation model on complex interventions from abroad. As an interdisciplinary technique, data mining involves database technology, artificial intelligence, machine learning, statistics, neural network and some other latest technologies, and has been widely used in the field of CM. Therefore, the application of data mining in the therapeutic evaluation of integrative medicine has broad prospects.
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Affiliation(s)
- Yu Qiu
- Beijing University of Chinese Medicine, China
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Given CW, Given BA, Sikorskii A, You M, Jeon S, Champion V, McCorkle R. Deconstruction of nurse-delivered patient self-management interventions for symptom management: factors related to delivery enactment and response. Ann Behav Med 2010; 40:99-113. [PMID: 20544405 PMCID: PMC2928661 DOI: 10.1007/s12160-010-9191-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This research examines the processes by which patient self-management interventions are related to symptom responses among cancer patients. A total of 333 patients from two randomized clinical trials were combined. Each patient received a six-contact 8-week patient self-management intervention delivered by a nurse to address symptoms. Nurses' decisions to deliver the strategies, patient enactment of strategies, and their success were investigated using patient- and symptom-level characteristics. Generalized estimating equation modeling accounted for clustering of symptoms and strategies delivered for each symptom within patient. Patient self-management intervention strategies were classified into four classes. Strategies were delivered by nurses for symptoms with higher interference and longer duration. Patient and symptom factors were related to enactment strategies. Symptom responses were related to number of strategies tried by patients. Delivery and enactment of strategies were related to both patient and symptom characteristics.
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Affiliation(s)
- Charles W Given
- Department of Family Medicine, Michigan State University, East Lansing, MI, USA.
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21
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Song MK, Happ MB, Sandelowski M. Development of a tool to assess fidelity to a psycho-educational intervention. J Adv Nurs 2010; 66:673-82. [PMID: 20423402 DOI: 10.1111/j.1365-2648.2009.05216.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This paper is a description of a method to develop and conduct a customized psycho-educational intervention fidelity assessment as part of pilot work for an efficacy study. A tool designed to assess treatment fidelity to a psycho-education intervention for patients with end-stage renal disease and their surrogate decision makers, Sharing the Patient's Illness Representations to Increase Trust, is presented as an illustration. BACKGROUND Despite the specificity and idiosyncrasy of individual interventions and the call to systematically evaluate treatment fidelity, how to accomplish this goal has not been clarified. Tools to adequately measure treatment fidelity are lacking. METHODS We developed the Sharing the Patient's Illness Representations to Increase Trust Treatment Fidelity Assessment tool by identifying elements that were idiosyncratic to the intervention and those that could be adapted from existing tools. The tool has four components: overall adherence to the intervention content elements; pacing of the intervention delivery; overall dyad responsiveness; and, overall quality index of intervention delivery. The study was undertaken between 2006 and 2008. RESULTS Inter-rater reliability ranged from 0.80 to 0.87 for the four components. The tool showed utility in training and monitoring, such as detecting unplanned content elements delivered and the use of proscribed communication behaviours. CONCLUSION Psycho-educational interventions are one of the most common types of nursing interventions worldwide. Use of fidelity assessment tools customized to the individual interventions may enhance systematic evaluation of training and monitoring treatment fidelity.
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Affiliation(s)
- Mi-Kyung Song
- University of North Carolina at Chapel Hill School of Nursing, USA.
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Spillane V, Byrne MC, Byrne M, Leathem CS, O'Malley M, Cupples ME. Monitoring treatment fidelity in a randomized controlled trial of a complex intervention. J Adv Nurs 2008; 60:343-52. [PMID: 17908130 DOI: 10.1111/j.1365-2648.2007.04386.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This paper is a report of a study to describe how treatment fidelity is being enhanced and monitored, using a model from the National Institutes of Health Behavior Change Consortium. BACKGROUND The objective of treatment fidelity is to minimize errors in interpreting research trial outcomes, and to ascribe those outcomes directly to the intervention at hand. Treatment fidelity procedures are included in trials of complex interventions to account for inferences made from study outcomes. Monitoring treatment fidelity can help improve study design, maximize reliability of results, increase statistical power, determine whether theory-based interventions are responsible for observed changes, and inform the research dissemination process. METHODS Treatment fidelity recommendations from the Behavior Change Consortium were applied to the SPHERE study (Secondary Prevention of Heart DiseasE in GeneRal PracticE), a randomized controlled trial of a complex intervention. Procedures to enhance and monitor intervention implementation included standardizing training sessions, observing intervention consultations, structuring patient recall systems, and using written practice and patient care plans. The research nurse plays an important role in monitoring intervention implementation. FINDINGS Several methods of applying treatment fidelity procedures to monitoring interventions are possible. The procedure used may be determined by availability of appropriate personnel, fiscal constraints, or time limits. Complex interventions are not straightforward and necessitate a monitoring process at trial stage. CONCLUSION The Behavior Change Consortium's model of treatment fidelity is useful for structuring a system to monitor the implementation of a complex intervention, and helps to increase the reliability and validity of evaluation findings.
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Affiliation(s)
- Valerie Spillane
- Department of General Practice, National University of Ireland, Galway, Ireland
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Perrin KM, Burke SG, O'Connor D, Walby G, Shippey C, Pitt S, McDermott RJ, Forthofer MS. Factors contributing to intervention fidelity in a multi-site chronic disease self-management program. Implement Sci 2006; 1:26. [PMID: 17067388 PMCID: PMC1636065 DOI: 10.1186/1748-5908-1-26] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Accepted: 10/26/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design. METHODS The Florida Health Literacy Study (FHLS) was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance. RESULTS This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation. CONCLUSION Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.
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Affiliation(s)
- Karen M Perrin
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Somer Goad Burke
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | | | - Gary Walby
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Claire Shippey
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Seraphine Pitt
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Robert J McDermott
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Melinda S Forthofer
- College of Social Work, University of South Carolina, Columbia, South Carolina, USA
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Alkema GE, Frey D. Implications of translating research into practice: a medication management intervention. Home Health Care Serv Q 2006; 25:33-54. [PMID: 16803737 DOI: 10.1300/j027v25n01_03] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Through programs such as the Administration on Aging's Evidence-Based Prevention Initiative, researchers and practitioners are developing translational research studies seeking to implement rigorously tested, evidence-based interventions in new practice settings and evaluate the continuing effectiveness of these interventions. One such translational study is the Community-Based Medications Management Intervention (CBM Intervention), a collaborative effort to implement a medication management screening and intervention protocol in community-based waiver care management programs. The overall goals of the CBM Intervention are to implement an evidence-based medication management intervention in a California Medicaid waiver care management program, and to evaluate the effect of client-, intervention-, and organizational-level characteristics on resolving identified medication problems. This article presents the need for improved medication management in a frail, community-dwelling, older adult population and describes the CBM Intervention as an example of translating an evidence-based practice beyond its original efficacy trial in a home healthcare program into a care management program. It discusses critical factors involved in translating research into practice using a translational research framework, Promoting Action on Research Implementation in Health Services (PARIHS). Our experience suggests that although implementing research into practice can positively impact client care, professional skill enhancement and organizational effectiveness, this is very challenging work requiring signification facilitation for successful outcomes.
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Affiliation(s)
- Gretchen E Alkema
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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Kearney MH, Simonelli MC. Intervention fidelity: Lessons learned from an unsuccessful pilot study. Appl Nurs Res 2006; 19:163-6. [PMID: 16877196 DOI: 10.1016/j.apnr.2005.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 11/15/2005] [Indexed: 10/24/2022]
Abstract
Although the design of the study we undertook was randomized, the groups were statistically similar, the intervention was based on evidence of previous efficacy, and the treatment was delivered exactly as planned, this pilot study on an intervention to promote motivation for weight loss in new mothers failed to produce an effect. A closer examination using criteria for intervention fidelity revealed a number of weaknesses. Both treatment integrity and differentiation merit careful consideration in intervention design.
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Affiliation(s)
- Margaret H Kearney
- PhD and MS-PhD Programs, University of Rochester School of Nursing, Rochester, NY 14642, USA.
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Solomon J, Card JJ, Malow RM. Adapting efficacious interventions: advancing translational research in HIV prevention. Eval Health Prof 2006; 29:162-94. [PMID: 16645183 DOI: 10.1177/0163278706287344] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Human Immunodeficiency Virus (HIV) has infected approximately 1.5 million people in the United States. Type 1 translation research (basic research, methods development, and efficacy trials) has yielded multiple efficacious behavioral HIV prevention programs. Type 2 translation research (dissemination and effectiveness studies) has been less prevalent or successful. Adaptation of efficacious interventions for culturally diverse populations has received increasing researcher attention, and empirical validation of adaptation procedures promises to help bridge the gap between Type 1 and Type 2 studies. In this article, the authors briefly discuss the development, testing, and dissemination of efficacious HIV prevention programs and then focus on research-based principles and processes that can guide researchers'adaptation efforts and steps that researchers can take to help empower practitioners to conduct science-based adaptation. Greater collaboration between researchers and service providers to test adaptation frameworks promises to benefit both research and practice.
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Abstract
PURPOSE Intervention studies that address the goals of the Healthy People initiative are increasing, and many focus on health concerns of children and adolescents. The purpose of this paper is to present strategies and discuss the rationale for including intervention fidelity in study design. CONCLUSION Researchers need to verify that their interventions were delivered as designed (intervention fidelity), and that variations from the design can be assessed. Infidelity can result in non-significant findings that are not due to the study design but rather to elements that affected the intervention delivery. IMPLICATIONS Addressing intervention fidelity in study design supports the researcher's conclusion about associations between intervention and outcomes and helps reduce premature abandonment of potentially useful interventions.
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Affiliation(s)
- Sharon Horner
- University of Texas at Austin, School of Nursing, Austin, TX, USA.
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