ENhancing Assessment of Common Therapeutic factors (ENACT) tool: adaptation and psychometric properties in South Africa

Abstract

Background The ENhancing Assessment of Common Therapeutic factors (ENACT) tool measures a set of therapeutic competencies required for the effective psychological intervention, including delivery by non-specialists. This paper describes the systematic adaptation of the ENACT for the South African (SA) context and presents the tool's initial psychometric properties. Methods We employed a four-step process: (1) Item generation: 204 therapeutic factors were generated by SA psychologists and drawn from the original ENACT as potential items; (2) Item relevance: SA therapists identified 96 items that were thematically coded according to their relationship to one another and were assigned to six domains; (3) Item utility: The ENACT-SA scale was piloted by rating recordings of psychological therapy sessions and stakeholder input; and (4) Psychometric properties: Internal consistency and inter-rater reliability of the final 12-item ENACT-SA were explored using Cronbach's alpha and intraclass correlation co-efficient (ICC) for both clinical psychologists and registered counsellors. Results Although the original ENACT provided a framework for developing a tool for use in SA, several modifications were made to improve the applicability of the tool for the SA context, and optimise its adaptability other contexts. The adapted 12-item tool's internal consistency was good, while the inter-rater reliability was acceptable for both clinical psychologists and registered counsellors. Conclusion The ENACT-SA is a reliable tool to assess common factors in psychological treatments. It is recommended that the tool be used in conjunction with assessment protocols and treatment-specific competency measures to fully assess implementation fidelity and potential mechanisms of therapeutic change.

Comparing dedicated and designated approaches to integrating task-shared psychological interventions into chronic disease care in South Africa: a three-arm, cluster randomised, multicentre, open-label trial

“…Three sessions of MI and PST, with an optional booster session, to be delivered weekly 26 During weekly individual supervision, the supervisor provided feedback on ways to enhance fidelity and improve counselling quality.…”

Piloting Siyakhana: A community health worker training to reduce substance use and depression stigma in South African HIV and TB care

“…Please see S1 File for an overview of the roleplay instructions. Role plays were conducted in English and followed standardized procedures established in prior work with lay health workers (described below) [ 32 , 33 ]. Participants attended the CHW training after completing the pre-training assessment.…”

“…Clinical skills were observed during standardized role plays and assessed with the ENhancing Assessment of Common Therapeutic Factors (ENACT) tool [ 32 ]. The ENACT is a widely used tool for assessing lay health worker competence in delivering mental health interventions and has previously been used in South Africa [ 33 ]. Fifteen competencies (e.g., non-verbal communication, empathy, explanation of confidentiality, collaborative goal setting) are rated across four levels (1 –harmful, 2 –some basic skills, 3 –all basic skills, 4 –advanced).…”

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“…For treatment-specific competencies (referred to as fidelity), an intervention delivery checklist was used including items pertaining to whether the objectives of the intervention session were addressed adequately. Further, a South African version of the ENhancing Assessment of Common Therapeutic Factors was used to measure core therapeutic competencies and skills thought to be required for a counsellor to adequately deliver any evidence-based intervention (Spedding et al, 2022).…”