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Objectives:To identify the definitions used for treatment fidelity in the behaviour change literature and to explore the extent to which the assessment of fidelity has been reported according to the five domains by Bellg et al. Methods:Three data bases (Scopus, Medline Ovid and CINAHL) were searched.Results were limited to studies published between 2012 and 2015.Definitions/summaries of treatment fidelity used were recorded. Methods for assessing/monitoring treatment fidelity were extracted, summarised and categorised according to the five domains.Results: Sixty-five papers were included for analysis. A definition of treatment fidelity was provided by n=34 studies; n=9 defined fidelity according to Bellg et al. In the context of treatment fidelity n=9 (13.8%) reported on study design; n=22 (33.8%) reported on an element of training of providers; n=59 (90.7%) papers reported on delivery of treatment; n=13 (20%) reported on receipt of treatment; and n=10 (15.3%) reported on enactment of treatment skills. Conclusion:The definitions of treatment fidelity in the literature and the extent to which it has been reported were limited. Delivery of treatment was the most frequently reported component of treatment fidelity but other important aspects were poorly reported. The potential consequence of this is that translation of research interventions into clinical practice may not be optimised.Key words: Treatment fidelity; behaviour change; physiotherapy; physical activity; exercise 2 2 IntroductionThe concept of treatment fidelity has evolved over time;1 and there does not appear to be one single agreed definition. Treatment fidelity can refer to all the mechanisms that ensure an intervention tests its hypothesis and that all the components of the intervention are implemented as outlined in the protocol. There does however appear to be an agreement in the literature of the importance of assessing and monitoring treatment fidelity. Firstly treatment fidelity increases the internal validity of a trial such that the results of the trial are directly attributable to the intervention. 2 Good treatment fidelity also increases the reproducibility of the trial by enhancing external validity; this increases to the extent to which the results can be generalised to the clinical setting. 1-3 Additionally optimisation of fidelity can also increase the statistical power of an intervention as the varability in delivery has been minimised. 1,[3][4] If the results of a trial are found to be non-significant and fidelity has not been monitored, it would be unclear if the results were due to an ineffective intervention or whether key elements of the trial were not implemented as planned. Conversely lack of attention to treatment fidelity could find an intervention to be effective due to extra treatment factors, potentially resulting in an ineffective intervention being found to be significant in a trial and subsequent implemented in clinical practice. [2][3]5 Finally fidelity monitoring can aid researchers in moving forward and refining int...

Childhood obesity increases the risk for poor health during childhood, as well as for adult obesity and its associated comorbidities. Children from racial/ethnic minority groups or who live in poverty experience elevated rates of obesity. One potential method for reducing childhood obesity disparities is to involve community health workers (frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served). The purpose of this systematic review and meta-analysis was to explore the role and effectiveness of community health workers in childhood obesity interventions. Eleven studies met inclusion criteria, of which nine were eligible for inclusion in the meta-analysis. Results demonstrated that community health workers played various roles in childhood obesity interventions in the home, clinic, school, and community setting. Interventions focused primarily on children from underserved populations. Meta-analytic findings demonstrated a small but significant impact on BMIz and BMI percentile (BMIz [7 studies]: -0.08, 95% CI: -0.15, -0.01, p = 0.03, I = 39.4%; BMI percentile [2 studies]: -0.25, 95% CI: -0.38, -0.11, p < 0.01, I = 0%). Findings from this review demonstrate that partnering with community health workers may be an important strategy for reducing childhood obesity disparities and advancing health equity.

Simple and low-cost interventions can considerably improve the clinical effectiveness of HCC screening programmes in real world settings. Clinical practice improvement principles appear to be a valid methodology for achieving this positive change.

There is a high prevalence of HO and vitamin D deficiency in patients with cirrhosis at presentation irrespective of disease severity or underlying aetiology.