Implementation fidelity of a self-management course for epilepsy: method and assessment

Background Complex interventions such as self-management courses are difficult to evaluate due to the many interacting components. The way complex interventions are delivered can influence the effect they have for patients, and can impact the interpretation of outcomes of clinical trials. Implementation fidelity evaluates whether complex interventions are delivered according to protocol. Such assessments have been used for one-to-one psychological interventions; however, the science is still developing for group interventions. Methods We developed and tested an instrument to measure implementation fidelity of a two-day self-management course for people with epilepsy, SMILE(UK). Using audio recordings, we looked at adherence and competence of course facilitators. Adherence was assessed by checklists. Competence was measured by scoring group interaction, an overall impression score and facilitator “didacticism”. To measure “didacticism”, we developed a novel way to calculate facilitator speech using computer software. Using this new instrument, implementation fidelity of SMILE(UK) was assessed on three modules of the course, for 28% of all courses delivered. Results Using the instrument for adherence, scores from two independent raters showed substantial agreement with weighted Kappa of 0.67 and high percent agreement of 81.2%. For didacticism, the results from both raters were highly correlated with an intraclass coefficient of 0.97 (p  50% of scored items received the maximum of 2 points) and high competence. Groups were interactive (mean score: 1.9–2.0 out of 2) and the overall impression was on average assessed as “good”. Didacticism varied from 42% to 93% of total module time and was not associated with the other competence scores. Conclusion The instrument devised to measure implementation fidelity was reproducible and easy to use. The courses for the SMILE(UK) study were delivered with a good level of adherence to protocol while not compromising facilitator competence. Trial registration ISRCTN57937389. Electronic supplementary material The online version of this article (doi:10.1186/s12874-017-0373-x) contains supplementary material, which is available to authorized users.

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PID https://www.doi.org/10.1186/s12874-017-0373-x
PID pmc:PMC5504680
PID pmid:28697723
URL https://doi.org/10.1186/s12874-017-0373-x
URL http://livrepository.liverpool.ac.uk/3008459/1/Wojewodka%20et%20al%202017_BMC%20Medical%20Research%20Methodology.pdf
URL http://www.scopus.com/inward/record.url?scp=85022334488&partnerID=8YFLogxK
URL https://link.springer.com/article/10.1186/s12874-017-0373-x
URL http://link.springer.com/article/10.1186/s12874-017-0373-x
URL https://bmcmedresmethodol.biomedcentral.com/track/pdf/10.1186/s12874-017-0373-x
URL https://kclpure.kcl.ac.uk/portal/files/73822431/Wojewodka_et_al_2017.pdf
URL https://core.ac.uk/display/102250161
URL https://kclpure.kcl.ac.uk/ws/files/73822431/Wojewodka_et_al_2017.pdf
URL http://dx.doi.org/10.1186/s12874-017-0373-x
URL https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-017-0373-x
URL https://qmro.qmul.ac.uk/xmlui/handle/123456789/25095
URL https://livrepository.liverpool.ac.uk/3008459/
URL https://academic.microsoft.com/#/detail/2736290822
URL https://kclpure.kcl.ac.uk/portal/en/publications/implementation-fidelity-of-a-selfmanagement-course-for-epilepsy(315065ff-496e-4a4b-8814-7878ce1896af).html
URL http://europepmc.org/articles/PMC5504680
URL https://doaj.org/toc/1471-2288
URL http://link.springer.com/content/pdf/10.1186/s12874-017-0373-x.pdf
URL https://dx.doi.org/10.1186/s12874-017-0373-x
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Author Gabriella Monika Wojewodka, 0000-0003-4635-4800
Author Laura Hilary Goldstein, 0000-0001-9387-3035
Author Leone Lorna Ridsdale, 0000-0002-2234-2859
Author Adam Noble, 0000-0002-8070-4352
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Collected From Europe PubMed Central; PubMed Central; ORCID; Datacite; UnpayWall; DOAJ-Articles; Crossref; Microsoft Academic Graph; King's Research Portal; CORE (RIOXX-UK Aggregator)
Hosted By Europe PubMed Central; BMC Medical Research Methodology; University of Liverpool Repository; King's Research Portal
Journal BMC Medical Research Methodology, 17,
Publication Date 2017-07-11
Publisher BioMed Central
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Country United Kingdom
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Language English
Resource Type Other literature type; Article; UNKNOWN
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Source https://science-innovation-policy.openaire.eu/search/publication?articleId=dedup_wf_001::a5781aee2eafa1e19171ad17e3241246
Author jsonws_user
Last Updated 22 December 2020, 10:25 (CET)
Created 22 December 2020, 10:25 (CET)