How Has Intervention Fidelity Been Assessed in Smoking Cessation Interventions? A Systematic Review

Abstract

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.

How is the Behavior Change Technique Content of the NHS Diabetes Prevention Program Understood by Participants? A Qualitative Study of Fidelity, With a Focus on Receipt

“…Following recent calls for more analyses of the potential association between fidelity assessments with health outcomes [ 15 ], it may be beneficial to compare findings from our work on all domains of fidelity with research on the effectiveness of the NHS-DPP on risk of T2DM (HbA1C) and weight loss. A previous study has analyzed health outcomes in a sample of completers of the NHS-DPP referred to the program prior to March 2018 [ 5 ].…”

“…Findings from fidelity assessments can often inform implementation of programs in practice and identify solutions for more effective roll-out of programs. Despite the importance of understanding fidelity, there has been a lack of attention in the field [ 14 ], wide variability in approaches to measuring fidelity [ 14 , 15 ], and a call for high quality measures of fidelity to be developed [ 16 ].…”

Exploring the Black Box of an mHealth Intervention (LIFE4YOUth): A Qualitative Process and Outcome Evaluation of End-User Engagement

“…The findings of this study can be useful when interpreting the results from other evaluations of the LIFE4YOUth intervention, such as quantitative mediator analysis and quantitative engagement analysis. Investigating the interaction processes echoes with the term receipt fidelity, which is often overlooked among intervention fidelity research [ 22 , 29 ]. The term “receipt” is contrasted with delivery and enactment by referring to an individual’s cognitive uptake of a delivered intervention as separate from behavioral responses [ 46 ].…”

“…Indeed, end-users of mHealth interventions typically use these interventions on their own, in contrast to face-to-face interventions which include on-going interaction and monitoring of the health care professional [ 24 ]. In addition, despite potential advantages of using qualitative methods to capture intervention-user interactions [ 25 , 26 , 27 , 28 ], systematic reviews show that most studies which have investigated users’ understanding, performance, and accuracy of intervention-related skills, such as the ability to recall information, are based on self-reported surveys [ 22 , 29 ].…”

The case for prioritizing implementation strategy fidelity measurement: benefits and challenges

“…Recent reviews of intervention fidelity call for the development and utilization of higher quality fidelity measures [ 55 , 56 ]. We share these sentiments as they relate to implementation strategy fidelity.…”