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Reporting of treatment fidelity in behavioural paediatric obesity intervention trials: a systematic review
M M JaKa1,2, J L Haapala2, E S Trapl3
1HealthPartners Institute, Bloomington, USA.
Insights
Reporting of treatment fidelity in pediatric obesity randomized controlled trials is inconsistent. While treatment design is often reported, delivery and enactment details are lacking, hindering intervention optimization.
Area of Science:
- Pediatric Health
- Behavioral Interventions
- Obesity Research
Background:
- Behavioral interventions show promise for pediatric obesity.
- Optimizing these interventions requires detailed treatment fidelity information.
- Current reporting practices for treatment fidelity in this field are largely unknown.
Purpose of the Study:
- To systematically review and describe the methods used for reporting treatment fidelity in pediatric obesity randomized controlled trials (RCTs).
- To identify gaps in the reporting of treatment fidelity components.
- To provide recommendations for improving treatment fidelity reporting in future research.
Main Methods:
- Systematic review conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Treatment fidelity was double-coded using the National Institutes of Health Fidelity Framework checklist.
- Included 300 articles representing 193 studies, with high inter-coder reliability (0.83).
Main Results:
- Reporting of treatment design elements was high (e.g., session length designed: 77%).
- Reporting of treatment delivery and enactment domains was low (e.g., session length delivered: 7%).
- Few studies reported gold-standard fidelity evaluation methods like coding delivered content.
- Higher study quality and publication frequency correlated with better fidelity reporting.
Conclusions:
- Significant gaps exist in reporting the full spectrum of treatment fidelity in pediatric obesity RCTs.
- There has been no improvement in reporting frequency over time.
- Recommendations are provided to enhance the rigor of treatment fidelity measurement and reporting in pediatric obesity research.
Abstract:
Behavioural interventions for paediatric obesity are promising, but detailed information on treatment fidelity (i.e. design, training, delivery, receipt and enactment) is needed to optimize the implementation of more effective interventions. Little is known about current practices for reporting treatment fidelity in paediatric obesity studies. This systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, describes the methods used to report treatment fidelity in randomized controlled trials. Treatment fidelity was double-coded using the National Institutes of Health Fidelity Framework checklist. Three hundred articles (N = 193 studies) were included. Mean inter-coder reliability across items was 0.83 (SD = 0.09). Reporting of treatment design elements within the field was high (e.g. 77% of studies reported designed length of treatment session), but reporting of other domains was low (e.g. only 7% of studies reported length of treatment sessions delivered). Few reported gold standard methods to evaluate treatment fidelity (e.g. coding treatment content delivered). General study quality was associated with reporting of treatment fidelity (p < 0.01) as was the number of articles published for a given study (p < 0.01). The frequency of reporting treatment fidelity components has not improved over time (p = 0.26). Specific recommendations are made to support paediatric obesity researchers in leading health behaviour disciplines towards more rigorous measurement and reporting of treatment fidelity.
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