Measuring implementation fidelity of school-based obesity prevention programmes: a systematic review

Area of Science:

• Public Health
• Health Promotion
• Childhood Obesity

Background:

• Implementation fidelity is crucial for the success of school-based obesity prevention programs.
• Current assessments of fidelity in these programs lack a clear overview and standardized methodology.
• This review addresses the need for a comprehensive understanding of how fidelity is assessed.

Purpose of the Study:

• To identify fidelity components measured in school-based obesity prevention programs.
• To determine the methods used for measuring these fidelity components.
• To evaluate the quality of the methods employed in fidelity assessment.

Main Methods:

• Systematic review of studies published between January 2001 and October 2017.
• Searches conducted across major databases (PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, ERIC).
• Inclusion of studies on school-based obesity prevention programs (nutrition, physical activity, sitting) for children aged 4-18, measuring at least one fidelity component; quality assessment using 7 criteria.

Main Results:

• 73 articles from 63 studies were included, with 120 fidelity components measured.
• Dose (N=50), responsiveness (N=36), and adherence (N=26) were most frequently measured.
• Methods varied significantly; observations, logbooks, and teacher questionnaires were common, but most fidelity components scored low quality (n=77).

Conclusions:

• There is a lack of consensus on operationalizing concepts and methods for assessing fidelity in school-based obesity prevention programs.
• The quality of current fidelity measurement methods is weak, hindering program effectiveness.
• Recommendations include establishing consensus on concepts, clear reporting of methods, and investigating the link between fidelity and program outcomes.