Implementation strategy fidelity evaluation for a multidisciplinary Chest Injury Protocol (ChIP)

Abstract

BackgroundBlunt chest wall injuries can lead to complications, especially without early intervention. A blunt chest injury protocol (ChIP) was developed to help improve consistency of evidence-based care following admission to emergency. Implementation strategy fidelity is the extent to which the strategies of implementation are delivered in line with the intended plan. The aim of this paper was to assess fidelity to the strategies of the implementation plan developed for ChIP. MethodsA retrospective evaluation of strategies used for implementation was performed, specifically the behaviour change techniques (BCTs). BCTs were used as part of an implementation plan derived based on the Behaviour Change Wheel from results from a staff survey at two hospitals. Levels of implementation or adaptation for BCTs were scored by implementers as follows; ‘Were the behaviour change interventions implemented?’ (0 = ‘not implemented’, 1 = partially-implemented, and 2 = fully-implemented); ‘Were adaptations made to the implementation plan?’. Scored 1 (many changes from plan) to 4 (just as planned). Free text explanation to their responses was also collected with supporting evidence and documentation (such as emails, implementation checklists, audit reports, and incident reports). ResultsThere was high overall fidelity of 97.6% for BCTs partially or fully implemented. More than three quarters (32/42, 76.2%) of the BCTs were fully-implemented with an additional 9/42 (21.4%) partially implemented. BCTs that were not fully implemented were social support, feedback on behaviour, feedback on outcomes of behaviour, adding objects to the environment, and restructuring the environment. The modes of delivery with poorer implementation or increased adaptations were clinical champions and audit/feedback.ConclusionsThis study advances implementation theory and research by presenting a novel method of evaluating implementation strategy fidelity, combining previously used methods. The systematic use and application of the behaviour change wheel was used to develop an implementation plan and was associated with high implementation strategy fidelity. A fidelity checklist developed during the implementation process may help implementers assess fidelity. Trial registration Trial registered on ANZCTR. Registration number ACTRN12618001548224, date approved 17/09/2018

Implementation of a hospital-wide multidisciplinary blunt chest injury care bundle (ChIP): Fidelity of delivery evaluation

“…26 The fidelity to the implementation plan for ChIP has been evaluated and previously reported as 97.6% fully or partially implemented as intended. 27 A logic map depicts the intervention functions, BCTs, and modes of delivery used across the two sites; partially shaded areas represent BCTs partially implemented (21.4%), and filled boxes represent BCTs and modes that were fully implemented (76.2%) (Supplementary file 4). 27 The fidelity of the intervention (ChIP), also referred to as 'fidelity of delivery' or 'treatment fidelity', 28 has not yet been evaluated.…”

“…27 A logic map depicts the intervention functions, BCTs, and modes of delivery used across the two sites; partially shaded areas represent BCTs partially implemented (21.4%), and filled boxes represent BCTs and modes that were fully implemented (76.2%) (Supplementary file 4). 27 The fidelity of the intervention (ChIP), also referred to as 'fidelity of delivery' or 'treatment fidelity', 28 has not yet been evaluated. The Medical Research Council guideline for process evaluations of complex interventions recommends that 'reach', 'fidelity', and 'dose' are evaluated as appropriate to the specific study and intervention.…”