Assessment of fidelity in individual level behaviour change interventions promoting physical activity among adults: a systematic review

Abstract

BackgroundBehaviour change interventions that promote physical activity have major implications for health and well-being. Measuring intervention fidelity is crucial in determining the extent to which an intervention is delivered as intended, therefore increasing scientific confidence about effectiveness. However, we lack a clear overview of how well intervention fidelity is typically assessed in physical activity trials.MethodsA systematic literature search was conducted to identify peer - reviewed physical activity promotion trials that explicitly measured intervention fidelity. Methods used to assess intervention fidelity were categorised, narratively synthesised and critiqued using assessment criteria from NIH Behaviour Change Consortium (BCC) Treatment Fidelity Framework (design, training, delivery, receipt and enactment).ResultsTwenty eight articles reporting of twenty one studies used a wide variety of approaches to measure intervention fidelity. Delivery was the most common domain of intervention fidelity measured. Approaches used to measure fidelity across all domains varied from researcher coding of observational data (using checklists or scales) to participant self-report measures. There was considerable heterogeneity of methodological approaches to data collection with respect to instruments used, attention to psychometric properties, rater-selection, observational method and sampling strategies.ConclusionsIn the field of physical activity interventions, fidelity measurement is highly heterogeneous both conceptually and methodologically. Clearer articulation of the core domains of intervention fidelity, along with appropriate measurement approaches for each domain are needed to improve the methodological quality of fidelity assessment in physical activity interventions. Recommendations are provided on how this situation can be improved.Electronic supplementary materialThe online version of this article (10.1186/s12889-017-4778-6) contains supplementary material, which is available to authorized users.

Translating a walking intervention for health professional delivery within primary care: A mixed‐methods treatment fidelity assessment

“…Firstly, the study made use of a comprehensive treatment fidelity framework (Bellg et al ., ), to conduct a methodologically rigorous assessment of the implementation of the delivery of a walking intervention by health care professionals to their own patients. As the staff delivering the intervention in this study were not members of the research team and were delivering the intervention as part of their routine work, the findings of the research are likely to be more representative of routine clinical practice, than many findings reported in the research literature (Lambert et al ., ; Walton et al ., ). However, it is possible that the intensity of contact between the research team and providers, as a result of monitoring and interview participation, may have contributed to the level of adherence identified in the present study.…”

“…When fidelity is investigated in studies of PA interventions, significant heterogeneity in methodological rigour and quality has been identified. A 2017 systematic review of treatment fidelity in PA behaviour change trials found only one study ensured providers were trained to a well‐defined a priori performance criterion, few studies used objective data collection methods to assess delivery; and the quality, expertise, and reliability of fidelity raters were rarely examined (Lambert et al ., ). Likewise, assessment of treatment receipt, that is, participant's understanding of the intervention content, was rarely investigated.…”

“…By contrast, treatment fidelity remains under‐researched in the PA literature (Lambert et al ., ; Quested, Ntoumanis, Thøgersen‐Ntoumani, Hagger, & Hancox, ). When fidelity is investigated in studies of PA interventions, significant heterogeneity in methodological rigour and quality has been identified.…”

Focusing on fidelity: narrative review and recommendations for improving intervention fidelity within trials of health behaviour change interventions

“…Physiotherapy behaviour change interventions (O'Shea, Mccormick, Bradley, & O'Neill, 2016) . Physical activity behaviour change (Lambert et al, 2017) 2. Limited focus beyond assessing fidelity of delivery .…”

Intervention fidelity in postintensive care follow‐up consultations at ten sites in the RAPIT‐trial: A mixed‐methods evaluation

“…The strengths of this study were the mixed data collection and integrating the qualitative component in a real-life setting to understand contextual factors during the intervention that might affect the outcome (Craig et al, 2013). A particular strength of our evaluation was addressing intervention fidelity based on a framework recommended by others (Lambert et al, 2017;Rixon et al, 2016).…”