Assessing intervention fidelity in a multi-level, multi-component, multi-site program: the Children's Healthy Living...

Area of Science:

• Public Health
• Chronic Disease Prevention
• Intervention Science

Background:

• Childhood obesity prevention requires multi-level, culturally relevant interventions.
• Existing models for monitoring fidelity across complex interventions are limited.
• The Children's Healthy Living (CHL) Program is a multi-level, multi-component intervention across five Pacific jurisdictions.

Purpose of the Study:

• To describe the fidelity-monitoring approach used in the CHL Program.
• To assess treatment fidelity across multiple intervention levels, components, and sites.
• To identify opportunities for intervention improvement.

Main Methods:

• Development of a fidelity-monitoring rubric.
• Random selection and independent interviews of community partners.
• Comparison and discussion of fidelity ratings between local staff and Coordinating Center representatives.

Main Results:

• Good agreement was found between local and Coordinating Center fidelity ratings (Kappa = 0.50, p < 0.001).
• The fidelity-monitoring approach successfully assessed the delivery of the multi-level, multi-component CHL intervention.
• Intervention improvement opportunities and adaptations were identified.

Conclusions:

• The described fidelity-monitoring approach is effective for complex, multi-site interventions.
• This method allows for timely identification of adaptations and areas for improvement.
• Successful fidelity assessment supports the effective delivery of public health interventions.