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

Abstract

Background Blunt chest wall injuries can lead to complications, especially without early intervention. A blunt Chest Injury Protocol (ChIP) was developed to help improve the consistency of evidence-based care following admission to the emergency department. Implementation strategy fidelity is the extent to which the strategies of implementation are delivered in line with the intended plan. The aim of this study was to assess fidelity to the strategies of the implementation plan developed for ChIP. Methods A 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). Results There 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. Conclusions This study describes the evaluation of implementation strategy fidelity in the acute care context. 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

Fidelity to the ACT SMART Toolkit: an instrumental case study of implementation strategy fidelity

“…Our instrumental case study assessment of fidelity to the ACT SMART Toolkit within ASD community agencies notably provides one of the first process models of assessing blended implementation strategy fidelity. Although a considerable amount of research has been conducted on intervention fidelity , few researchers have explored implementation strategy fidelity [ 37 , 52 , 53 ]. For example, Slaughter et al [ 37 ] found that no studies reporting on fidelity to implementation included a specific definition or theoretical framework for assessing implementation strategy fidelity.…”

“…Indeed, Slaughter et al [ 37 ] conducted a scoping review that indicated no articles reporting fidelity to implementation strategies included definitions or conceptual frameworks for assessing implementation strategy fidelity. To our knowledge, few studies have examined fidelity to an implementation strategy and only one recent study has used a guiding theoretical framework [ 52 , 53 ].…”

Fidelity to the ACT SMART Toolkit: An Instrumental Case Study of Implementation Strategy Fidelity

“…Taken together, our instrumental case study assessment of delity to the ACT SMART Toolkit and exploration of the potential relationship between delity and EBP use within ASD community agencies notably provide one of the rst models of assessing implementation strategy delity. Although a considerable amount of research has been conducted on intervention delity, few researchers have explored implementation strategy delity (35,49,50). For example, Slaughter et al (35) found that no studies reporting on delity to implementation included a speci c de nition or theoretical framework for assessing implementation strategy delity.…”

“…Indeed, Slaughter et al (35) conducted a scoping review that indicated no articles reporting delity to implementation strategies included de nitions or conceptual frameworks for assessing implementation strategy delity. To our knowledge, few studies have examined delity to an implementation strategy, and only one recent study has used a guiding theoretical framework (49,50).…”