Implementation fidelity of a voluntary sector-led diabetes education programme

Kok, Michelle S Y; Jones, Matthew; Solomon-Moore, Emma; Smith, Jane

doi:10.1108/he-04-2017-0019

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…The magnitude of weight loss observed was similar to the 1.6 to 2.5 kg reported in reviews of randomised controlled trials of real-world diabetes prevention interventions [15] and previous UK-based diabetes prevention studies [16, 17], though less than the 3-4 kg that might be expected for programmes fully implementing NICE guidance on the content of diabetes prevention interventions [15]. Reasons for this may include lower than planned contact time (data on contacts outside core group sessions were not consistently recorded), or variations from planned delivery (fidelity was checked only in a sub-sample at one site [28]).…”

Section: Discussionmentioning

confidence: 99%

“…staff were trained in using person-centred counselling techniques to build empathy and assess and enhance motivation with a focus on building the perceived importance of, and confidence in, making changes) reflected all 11 NICE recommendations for diabetes prevention interventions [3]. Fidelity of implementation was checked at one site, and as reported elsewhere [28], found to be high. Participant satisfaction with the programme is also reported elsewhere [29].…”

Section: Methodsmentioning

confidence: 99%

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The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme

Smith

Greaves

Thompson

et al. 2019

Int J Behav Nutr Phys Act

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ObjectiveThis two-site randomised trial compared the effectiveness of a voluntary sector-led, community-based diabetes prevention programme to a waiting-list control group at 6 months, and included an observational follow-up of the intervention arm to 12 months.MethodsAdults aged 18–75 years at increased risk of developing type 2 diabetes due to elevated blood glucose and being overweight were recruited from primary care practices at two UK sites, with data collected in participants’ homes or community venues. Participants were randomised using an online central allocation service. The intervention, comprising the prototype “Living Well, Taking Control” (LWTC) programme, involved four weekly two-hour group sessions held in local community venues to promote changes in diet and physical activity, plus planned follow-up contacts at two, three, six, nine and 12 months alongside 5 hours of additional activities/classes. Waiting list controls received usual care for 6 months before accessing the programme. The primary outcome was weight loss at 6 months. Secondary outcomes included glycated haemoglobin (HbA1c), blood pressure, physical activity, diet, health status and well-being. Only researchers conducting analyses were blinded.ResultsThe target sample of 314 participants (157 each arm) was largely representative of local populations, including 44% men, 26% from ethnic minorities and 33% living in deprived areas. Primary outcome data were available for 285 (91%) participants (141 intervention, 144 control). Between baseline and 6 months, intervention participants on average lost more weight than controls (− 1.7 kg, 95% CI − 2.59 to − 0.85). Higher attendance was associated with greater weight loss (− 3.0 kg, 95% CI − 4.5 to − 1.5). The prototype LWTC programme more than doubled the proportion of participants losing > 5% of their body weight (21% intervention vs. 8% control, OR 2.83, 95% CI 1.36 to 5.90) and improved self-reported dietary behaviour and health status. There were no impacts on HbA1c, blood pressure, physical activity and well-being at 6 months and, amongst intervention participants, few further changes from six to 12-months (e.g. average weight re-gain 0.36 kg, 95% CI − 0.20 to 0.91). There were no serious adverse events but four exercise-related injuries were reported in the intervention arm.ConclusionsThis voluntary sector-led diabetes prevention programme reached a broad spectrum of the population and had modest effects on weight-related outcomes, but limited impacts on other diabetes risk factors.Trial registrationTrial registration number: ISRCTN70221670, 5 September 2014Funder (National Institute for Health Research School for Public Health Research) project reference number: SPHR-EXE-PES-COM.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme

Smith

Greaves

Thompson

et al. 2019

Int J Behav Nutr Phys Act

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“…Many frameworks have been developed for assessing IF. Where applicable, some studies combine adherence and competence to assess IF [38,44,45] while other studies assessed only…”

Section: Conceptual Framework: the Conceptual Framework For Implementation Fidelitymentioning

confidence: 99%

“…Many studies have been conducted on IF from different disciplines [33]; in education [34], social work [35], engineering [36], construction [37] and health [16,38,39], the area of this study. IF is important in the process of translating evidence-based interventions into real-life practice.…”

Section: Introductionmentioning

confidence: 99%

Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana

et al. 2021

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Introduction Tuberculosis screening of people living with human immunodeficiency virus is an intervention recommended by the WHO to control the dual epidemic of TB and HIV. The extent to which the intervention is adhered to by the HIV healthcare providers (fidelity) determines the intervention’s effectiveness as measured by patient outcomes, but literature on fidelity is scarce. This study assessed provider implementation fidelity to national guidelines on TB screening at HIV clinics in Ghana. Methods It was a cross-sectional study that used structured questionnaires to gather data, involving 226 of 243 HIV healthcare providers in 27 HIV clinics across Ghana. The overall fidelity score comprised sixteen items with a maximum score of 48 grouped into three components of the screening intervention (TB diagnosis, TB awareness and TB symptoms questionnaire). Simple summation of item scores was done to determine fidelity score per provider. In this paper, we define the level of fidelity as low if the scores were below the median score and were otherwise categorized as high. Background factors potentially associated with implementation fidelity level were assessed using cluster-based logistic regression. Odds ratio with 95% confidence interval (CI) was used as the measure of association. Results Of the 226 healthcare providers interviewed, 60% (135) were females with a mean age of 34.5 years (SD = 8.3). Most of them were clinicians [63% (142)] and had post-secondary non-tertiary education [62% (141)]. Overall, 53% (119) of the healthcare providers were categorized to have implemented the intervention with high fidelity. Also, 56% (126), 53% (120), and 59% (134) of the providers implemented the TB diagnosis, TB awareness and TB symptoms questionnaire components respectively with high fidelity. After adjusting for cluster effect, female providers (AOR = 2.36, 95%CI: 1.09–5.10, p = <0.029), those with tertiary education (AOR = 4.31, 95%CI: 2.12–9.10, p = 0.040), and clinicians (AOR = 1.78, 95%CI: 1.07–3.50, p = 0.045) were more likely to adhere to the guidelines compared to their counterparts. Conclusion The number of providers with fidelity scores above the median was marginally greater (6%) than the number with fidelity score below the median. Similarly, for each of the components, the number of providers with fidelity scores higher than the median was marginally higher. This could explain the existing fluctuations in the intervention outcomes in Ghana. We found gender, profession and education were associated with provider implementation fidelity. To improve fidelity level among HIV healthcare providers, and realize the aims of the TB screening intervention among PLHIV in Ghana, further training on implementing all components of the intervention is critical.

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“…In evidence-based programs, implementation fidelity is a determinant for successful interventions. 9,10 Although a high degree of program fidelity could generate better results, many implementations stray from fidelity guidelines. 11 Programs might be expanded or truncated to fit into allotted class time or spread over a longer period of time (ie, several weeks) than intended.…”

Section: Purposementioning

confidence: 99%

Should We Worry About Setting? Association of Program Fidelity with Youths’ Satisfaction and Intention to Practice Safer Sex

Monalisa

Macauda

2021

Am J Health Promot

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Purpose: To examine whether deviation from fidelity in the implementation of an evidence-based program on safer sex education affected youth satisfaction and intention to avoid risky sexual behaviors. Design: Implementation evaluation. Setting: In-school and out-of-school settings in South Carolina. Participants: Three thousand seventy-three youths aged 10 to 14 years. Intervention: Making Proud Choices. Measures: Fidelity variables were implementation setting, program length, class size, gender composition, and curriculum adaptations. Outcome variables were youth program satisfaction and intentions to remain abstinent or avoid risky sexual behaviors postintervention. Analysis: Chi-square and t tests tested in-school and out-of-school comparisons. Multiple linear regression examined predictors of youth program satisfaction and intention to avoid risky behaviors. Results: Program duration ( B = .002), class size ( B = .074), program completion rate ( B = .004), gender ( B = .223), and race ( B = .263) predicted program satisfaction ( P < .05; R2 = 0.094). Longer program duration was negatively associated with planned abstinence ( B = −.002), contraception use ( B = −.004), and condom use ( B = −.002). Participants in single-gender classes ( B = .387) and females ( B = .256) were more likely to practice safer sex. Low R2 showed limited impact on intention to practice safer sex ( R2 = .030 and.015) and remaining abstinent ( R2 = .033). Conclusion: Although fidelity deviations do impact youth satisfaction and intentions, the impact is not large. Implementations adapted to fit local settings can still be beneficial.

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Implementation fidelity of a voluntary sector-led diabetes education programme

Cited by 4 publications

References 23 publications

The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme

The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme

Fidelity of implementation of TB screening guidelines by health providers at selected HIV clinics in Ghana

Should We Worry About Setting? Association of Program Fidelity with Youths’ Satisfaction and Intention to Practice Safer Sex

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