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Fidelity in complex behaviour change interventions: a standardised approach to evaluate intervention integrity
Tom Mars1, David Ellard, Dawn Carnes
1Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK.
BMJ Open
|November 19, 2013
Summary
This study developed tools to assess the COPERS self-management course for chronic pain. High adherence was observed, but facilitator competence varied, highlighting the need for robust fidelity evaluation in complex interventions.
Area of Science:
- Health Services Research
- Intervention Science
- Chronic Pain Management
Background:
- Complex interventions require rigorous fidelity assessment to ensure consistent delivery.
- The COping with persistent Pain, Effectiveness Research into Self-management (COPERS) course is a complex intervention for chronic pain.
- Evaluating intervention fidelity is crucial for understanding treatment effectiveness.
Purpose of the Study:
- To develop and test tools for monitoring the fidelity of the COPERS intervention.
- To provide recommendations for fidelity assessment in complex interventions.
Main Methods:
- A fidelity assessment was conducted within a two-arm randomised controlled trial.
- Three measures evaluated adherence, competence, and overall impression of facilitator delivery.
- 31 audio-recorded courses were evaluated, with a random sample of four components from each.
Main Results:
- Developed reliable fidelity measures with good face validity.
- Observed high adherence to the manual (median 2.00/2).
- Facilitator competence showed variability (median 1.50/2), with overall impression scores of 3.00/4.
Conclusions:
- Embedding fidelity measurement principles early in complex intervention design and training is efficient.
- Robust fidelity evaluation systems are necessary to support the growth of complex interventions.
- Continued work is needed to enhance fidelity evaluation methods for complex interventions.
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