Enhancing Treatment Fidelity in Health Behavior Change Studies: Best Practices and Recommendations From the NIH Behavior Change Consortium.

Abstract

Treatment fidelity refers to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. This article describes a multisite effort by the Treatment Fidelity Workgroup of the National Institutes of Health Behavior Change Consortium (BCC) to identify treatment fidelity concepts and strategies in health behavior intervention research. The work group reviewed treatment fidelity practices in the research literature, identified techniques used within the BCC, and developed recommendations for incorporating these practices more consistently. The recommendations cover study design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. Funding agencies, reviewers, and journal editors are encouraged to make treatment fidelity a standard part of the conduct and evaluation of health behavior intervention research.

Measures of fidelity of delivery of, and engagement with, complex, face‐to‐face health behaviour change interventions: A systematic review of measure quality

“…NIH Treatment fidelity model/NIH Behaviour change Consortium framework (Bellg et al ., 2004) ( n  = 6; 9.1%) 6,10,20,22,26,39 …”

“…The measures used to measure fidelity of delivery of, and engagement with, complex, face‐to‐face health behaviour change interventions were consistent with previous recommendations of using observational or self‐report measures to monitor fidelity of delivery, and self‐report measures to monitor engagement (Bellg et al ., 2004; Borrelli, 2011; Burgio et al ., 2001; Carroll et al ., 2007; Schinckus et al ., 2014). A similar percentage of studies used observational and self‐report measures to measure fidelity of delivery, despite observational measures being recommended as the gold‐standard measure and the reported limitations of self‐report measures (Bellg et al ., 2004; Borrelli, 2011; Breitenstein et al ., 2010; Lorencatto et al ., 2014; Schinckus et al ., 2014).…”

“…A similar percentage of studies used observational and self‐report measures to measure fidelity of delivery, despite observational measures being recommended as the gold‐standard measure and the reported limitations of self‐report measures (Bellg et al ., 2004; Borrelli, 2011; Breitenstein et al ., 2010; Lorencatto et al ., 2014; Schinckus et al ., 2014). Intervention records (e.g., attendance or homework) were also used to measure engagement.…”

“…The psychometric qualities that were most frequently reported were those recommended by previous research; examples of these are the use of multiple, independent researchers to reliably rate a random percentage of sessions for fidelity of delivery (Bellg et al ., 2004; Borrelli, 2011; Lorencatto et al ., 2014). However, some qualities which are recommended by research were not frequently reported; an example of this is routine audio‐recording (Gresham, Gansle, & Noell, 1993; Miller & Rollnick, 2014).…”

“…Methods used to assess engagement include self‐report measures (Bellg et al ., 2004; Burgio et al ., 2001; Carroll et al ., 2007), observation of skills (Burgio et al ., 2001), and homework reviews (Bellg et al ., 2004). Systematic reviews of measures used to monitor fidelity of delivery demonstrate that these measures have consistently been used in intervention research, in both educational (Maynard, Peters, Vaughn, & Sarteschi, 2013) and health settings (Rixon et al ., 2016).…”