Introduction. Intervention fidelity concerns the degree to which interventions are implemented as intended. Fidelity frameworks propose fidelity is a multidimensional concept relevant at intervention designer, provider, and recipient levels; yet the extent to which it is assessed multidimensionally is unclear. Smoking cessation interventions are complex, including multiple components, often delivered over multiple sessions and/or at scale in clinical practice; this increases susceptibility variation in the fidelity with which they are delivered. This review examined the extent to which five dimensions from the Behaviour Change Consortium fidelity framework (design, training, delivery, receipt, and enactment) were assessed in fidelity assessments of smoking cessation interventions (randomised control trials (RCTs)). Methods. Five electronic databases were searched using terms “smoking cessation,” “interventions,” “fidelity,” and “randomised control trials.” Eligible studies included RCTs of smoking cessation behavioural interventions, published post 2006 after publication of the framework, reporting assessment of fidelity. The data extraction form was structured around the framework, which specifies a number of items regarding assessment and reporting of each dimension. Data extraction included study characteristics, dimensions assessed, data collection, and analysis strategies. A score per dimension was calculated, indicating its presence. Results. 55 studies were reviewed. There was a wide variability in data collection approaches used to assess fidelity. Fidelity of delivery was the most commonly assessed and linked to the intervention outcomes (73% of the studies). Fidelity of enactment scored the highest according to the framework (average of 92.7%), and fidelity of training scored the lowest (average of 37.1%). Only a quarter of studies linked fidelity data to outcomes (27%). Conclusion. There is wide variability in methodological and analytical approaches that precludes comparison and synthesis. In order to realise the potential of fidelity investigations to increase scientific confidence in the interpretation of observed trial outcomes, studies should include analyses of the association between fidelity data and outcomes. Findings have highlighted recommendations for improving fidelity evaluations and reporting practices.

Aims To identify the barriers to and enablers of effective insulin self‐titration in people with Type 2 diabetes. Methods A qualitative semi‐structured interview approach was used. Questions were structured according to the Theoretical Domains Framework, which outlines 14 domains that can act as barriers to and enablers of changing behaviour. Interviews were audio‐recorded and transcribed verbatim. The data were coded according to the 14 domains, belief statements were created within each domain, and a frequency count of the most reported barriers and enablers was then carried out. Analyses were conducted by two researchers, and discrepancies agreed with a third researcher. Results A total of 18 adults with Type 2 diabetes took part in an interview. The majority were of South‐Asian ethnicity (n = 8) and were men (n = 12). Their mean age was 61 years old. The mean duration of diabetes was 16 years and time on insulin 9 years. Inter‐rater reliability for each of the domains varied (29–100%). The most frequently reported domains were Social Influence and Beliefs about Consequences; the least frequently reported were Optimism and Reinforcement. Interviewees reported receiving support to self‐titrate from a range of sources. Self‐titrating was perceived to have a range of both positive and negative consequences, as was not titrating. Conclusions The findings highlight that those interviewed experienced a range of barriers and enablers when attempting to self‐titrate. Improved education and training when initiating insulin treatment among adults with Type 2 diabetes, and throughout their journey on insulin therapy could help identify and address these barriers in order to optimize self‐titration.

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ObjectivesPhysical-distancing (i.e., keeping 1-2m apart when co-located) can prevent cases of infectious-diseases spread by droplets/aerosols (i.e. SARS-COV2). Distancing is a recommendation/requirement in many countries. This systematic-review aimed to determine which interventions and behaviour change techniques (BCTs) are effective in promoting adherence to physical-distancing and through which potential mechanisms of action (MOAs). MethodsSix databases were searched for studies of physical-distancing interventions. A narrative synthesis included any design that included a comparator (e.g., pre-intervention versus post-intervention; randomised controlled trial), for any population and year. Risk-of-bias was assessed using the Mixed Methods Appraisal Tool. BCTs and potential MoAs were identified in each intervention.. ResultsSix papers of moderate/high quality indicated that distancing interventions could successfully change MoAs/behaviour. Successful BCTs (MoAs) included feedback on behaviour (e.g., motivation); information about/ salience of health consequences (e.g., beliefs about consequences) and demonstration (e.g., beliefs about capabilities) and restructuring the physical environment (e.g., environmental context and resources). The most promising interventions were proximity buzzers, directional systems and posters with loss-framed messages that demonstrated the behaviours. ConclusionsHigh quality RCTs that measure behaviour, have representative samples and specify/test a larger range of BCTs /MoAs are needed.