The Prevention and Reactivation Care Program: intervention fidelity matters

Area of Science:

• Geriatric Medicine
• Healthcare Quality Improvement
• Implementation Science

Background:

• The Prevention and Reactivation Care Program (PReCaP) is a multidisciplinary approach to reduce functional decline in elderly patients during hospitalization.
• Assessing intervention fidelity is crucial for clinical trials in geriatrics, yet studies evaluating fidelity often lag behind efficacy studies.

Purpose of the Study:

• To systematically assess the intervention fidelity of the hospital phase of PReCaP during its first year.
• To understand factors moderating intervention fidelity and identify necessary modifications.
• To evaluate the feasibility of PReCaP fidelity assessment amidst intervention changes.

Main Methods:

• Developed a 19-component fidelity instrument based on PReCaP protocols.
• Employed mixed data collection: patient records, Goal Attainment Scaling plans, stakeholder interviews, and non-participant observations.
• Utilized descriptive analysis for fidelity levels and the Conceptual Framework for Implementation Fidelity to identify moderating factors.

Main Results:

• Ten out of nineteen PReCaP components were consistently or frequently delivered to twenty elderly patients.
• Facilitating strategies and contextual factors were identified as key moderators influencing adherence to specific intervention components.

Conclusions:

• Fidelity assessment of PReCaP in its first year at Vlietland Ziekenhuis showed commendable delivery of ten components.
• Intervention fidelity was significantly influenced by various moderating factors.
• Fidelity criteria should adapt to the evolving PReCaP intervention, necessitating repeated assessments for validity and reliability.