Intervention Fidelity Within Trials of Infant Feeding Behavioral Interventions to Prevent Childhood Obesity: A
Elaine Toomey1, Karen Matvienko-Sikar2, Caroline Heary3
1Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Room 2058, Arts Millennium Building, Galway, Ireland.
Insights
Intervention fidelity in infant feeding trials is moderately reported, potentially explaining inconsistent obesity prevention results. Enhancing reporting, especially provider training, is crucial for future research and practice.
Area of Science:
- Public Health
- Behavioral Science
- Pediatric Obesity Prevention
Background:
- Infant feeding interventions aim to prevent childhood obesity, but evidence of effectiveness is inconsistent.
- Intervention fidelity, the extent to which an intervention is implemented as intended, has not been previously examined in these trials.
- Lack of fidelity assessment limits the interpretation of existing research findings.
Purpose of the Study:
- To review the use and reporting of strategies to enhance and assess intervention fidelity in infant feeding intervention trials.
- To explore the association between intervention fidelity strategies and study quality, effectiveness, and publication year.
Main Methods:
- A systematic review of seven electronic databases was conducted.
- Articles were screened by two independent reviewers.
- The NIH Behaviour Change Consortium fidelity checklist assessed strategies across five domains: design, provider training, delivery, receipt, and enactment.
Main Results:
- Ten trials (16 papers) were included. Overall use/reporting of fidelity strategies was moderate (54%).
- Fidelity strategy reporting varied significantly across domains, from 15.9% for provider training to 95% for enactment.
- No association was found between fidelity reporting levels and study quality, effectiveness, or publication year.
Conclusions:
- Moderate intervention fidelity reporting suggests inconsistent effectiveness findings may stem from implementation variations.
- Improving reporting across all fidelity domains, particularly provider training and control group content, is essential.
- These improvements are critical for optimizing the translation of infant feeding research into practice and advancing behavior change literature.
Background:
Intervention fidelity refers to whether an intervention has been implemented as intended. Trials of infant feeding behavioral interventions to prevent childhood obesity show inconsistent evidence of effectiveness. However, intervention fidelity has not been previously explored within these trials, limiting interpretation of findings.
Purpose:
To review the use and/or reporting of strategies to enhance and assess intervention fidelity within trials of infant feeding interventions to prevent childhood obesity, and their association with study quality, effectiveness, and publication year.
Methods:
Seven electronic databases were searched, with articles screened for inclusion by two reviewers. The National Institutes of Health Behaviour Change Consortium fidelity checklist was used to assess use and/or reporting of fidelity strategies across five domains (design, provider training, delivery, receipt, and enactment).
Results:
Ten trials (16 papers) were identified. Average use/reporting of fidelity strategies was moderate (54%), ranging from 28.9% to 76.7%. Levels of use/reporting ranged from 15.9% in the domain of provider training to 95% for enactment. No association was found between these levels and study quality, effectiveness, or publication year.
Conclusions:
The moderate use/reporting of fidelity strategies within trials of infant feeding interventions suggests that previous findings of inconsistent effectiveness may not fully reflect the intended interventions. The review highlights key considerations for improving future research, both in the area of behavioral infant feeding and wider behavior change literature. This includes improving reporting across all fidelity domains and ensuring an enhanced focus on provider training and control group content to optimize the translation of research into practice.
Prospero Registration Number:
CRD42016033492.
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