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Operationalizing a model to quantify implementation of a multi-component intervention in a stepped-wedge trial.

Linnea Ferm1, Charlotte Diana Nørregaard Rasmussen1, Marie Birk Jørgensen2

  • 1National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark.

Implementation Science : IS
|February 10, 2018
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Summary

This study developed a quantifiable implementation evaluation model. The model effectively measured intervention delivery and receipt, showing uniform implementation across most factors but variation in components.

Keywords:
DeliveryFidelityPragmatic trialsProcess evaluationReceiptStepped-wedge design

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Area of Science:

  • Implementation Science
  • Health Services Research
  • Program Evaluation

Background:

  • Multifaceted interventions present challenges in interpreting results due to complex, hard-to-quantify program theories.
  • Evaluating the implementation process of complex interventions is crucial for understanding their effectiveness.

Purpose of the Study:

  • To develop a model for comprehensive quantitative implementation evaluation.
  • To operationalize this model within a stepped-wedge cluster randomized controlled trial evaluating an intervention for nurses' aides in elderly care.
  • To investigate differences in implementation across intervention components, steps, and settings.

Main Methods:

  • Developed a quantifiable implementation evaluation framework based on program logic and intervention protocol.
  • Defined and measured optimal intervention delivery (fidelity) and receipt (participation, responsiveness).
  • Calculated exposure (fidelity x participation) and overall implementation on a 0-100 scale.

Main Results:

  • High fidelity (91%) and delivery (95%) of intervention sessions were observed.
  • Average participation, fidelity, exposure, and responsiveness were 50%, 93%, 48%, and 89%, respectively.
  • Implementation was uniform across steps and workplaces but varied significantly across intervention components.

Conclusions:

  • A quantifiable implementation evaluation model was successfully developed and operationalized.
  • The model effectively measures participation, fidelity, exposure, and responsiveness.
  • This approach is suitable for comparing implementation across diverse factors and for analyzing the impact of complex interventions.