CULTURAL EDUCATION AS A SOLUTION TO IDENTITY CRISIS: DEVELOPMENT AND IMPLEMENTATION OF JARAN BODHAG-BASED LEARNING MODULES

PurposeThe quality of voluntary sector-led community health programmes is an important concern for service users, providers and commissioners. Research on the fidelity of programme implementation offers a basis for assessing and further enhancing practice. The purpose of this paper is to report on the fidelity assessment of Living Well Taking Control (LWTC) – a voluntary sector-led, community-based education programme in England focussing on the prevention and management of type 2 diabetes.Design/methodology/approachThis fidelity of implementation (FoI) study was conducted with the Devon-based LWTC programme. A fidelity checklist was developed to analyse audio records of group-based lifestyle education sessions – implementation was rated in terms of adherence to protocol and competence in delivery; the influence of wider contextual factors was also assessed. Kappa statistics (κ) were used to test for inter-rater agreement. Course satisfaction data were used as a supplementary indicator of facilitator competence.FindingsAnalysis of 28 sessions, from five diabetes prevention and two diabetes management groups (total participants, n=49), yielded an overall implementation fidelity score of 77.3 per cent for adherence (moderate inter-rater agreement, κ=0.60) and 95.1 per cent for competence (good inter-rater agreement, κ=0.71). The diabetes prevention groups consistently achieved higher adherence scores than the diabetes management groups. Facilitator competence was supported by high participant satisfaction ratings.Originality/valueAn appropriate level of implementation fidelity was delivered for the LWTC group-based education programme, which provides some confidence that outcomes from the programme reflected intervention effectiveness. This study demonstrates the viability of assessing the FoI in a voluntary sector-led public health initiative and the potential of this method for assuring quality and informing service development.

Establishing the feasibility and validity of implementation fidelity monitoring strategies is an important methodological step in implementing evidence-based interventions on a large scale. The objective of the study was to examine the reliability and validity of the Fidelity Checklist, a measure designed to assess group leader adherence and competence delivering a parent training intervention (the Chicago Parent Program) in child care centers serving low-income families. The sample included 9 parent groups (12 group sessions each), 12 group leaders, and 103 parents. Independent raters reviewed 106 audiotaped parent group sessions and coded group leaders' fidelity on the Adherence and Competence Scales of the Fidelity Checklist. Group leaders completed self-report adherence checklists and a measure of parent engagement in the intervention. Parents completed measures of consumer satisfaction and child behavior. High interrater agreement (Adherence Scale = 94%, Competence Scale = 85%) and adequate intraclass correlation coefficients (Adherence Scale = .69, Competence Scale = .91) were achieved for the Fidelity Checklist. Group leader adherence changed over time, but competence remained stable. Agreement between group leader self-report and independent ratings on the Adherence Scale was 85%; disagreements were more frequently due to positive bias in group leader self-report. Positive correlations were found between group leader adherence and parent attendance and engagement in the intervention and between group leader competence and parent satisfaction. Although child behavior problems improved, improvements were not related to fidelity. The results suggest that the Fidelity Checklist is a feasible, reliable, and valid measure of group leader implementation fidelity in a group-based parenting intervention. Future research will be focused on testing the Fidelity Checklist with diverse and larger samples and generalizing to other group-based interventions using a similar intervention model.

BackgroundDetermining whether complex rehabilitation interventions are delivered with fidelity is important. Implementation fidelity can differ between sites, therapists delivering interventions and, over time, threatening trial outcomes and increasing the risk of type II and III errors. This study aimed to develop a method of assessing occupational therapists’ fidelity to deliver a complex, individually tailored vocational rehabilitation (VR) intervention to people with traumatic brain injury (TBI) and assess the feasibility of its use in a randomised controlled trial.MethodsUsing mixed methods and drawing on the intervention logic model, we developed data collection tools to measure fidelity to early specialist TBI VR (ESTVR). Fidelity was measured quantitatively using intervention case report forms (CRF), fidelity checklists and clinical records. Qualitative data from mentoring records, interviews with intervention therapists, participants with TBI, employers and NHS staff at trial sites explored moderators of implementation fidelity. The conceptual framework of implementation fidelity (CFIF) guided measurement and analysis of and factors affecting fidelity. Data were triangulated and benchmarked against an earlier cohort study.ResultsFidelity to a complex individually tailored VR intervention could be measured. Overall, OTs delivered ESTVR with fidelity. Different fidelity measures answered different questions, offering unique insights into fidelity. Fidelity was best assessed using a fidelity checklist, intervention CRFs and clinical notes. The OT clinical notes and mentoring records were best at identifying fidelity moderating factors. Interviews added little insight into fidelity moderating factors over and above mentoring or clinical records. Data triangulation offered a comprehensive assessment of fidelity, highlighting limitations of measurement methods and learning for future trials but was resource intensive. Interviews, fidelity visits and analysing clinical notes were also resource intense. Comparing fidelity data to a benchmark and using CFIF as a framework for organising the fidelity assessment helped.ConclusionsOTs delivered the VR intervention with fidelity. A fidelity checklist and benchmark plus mentoring may offer a practical and effective way of measuring fidelity and identifying fidelity moderating factors in trials of complex individually-tailored rehabilitation interventions. Mentoring provided real-time indicators of and reasons for fidelity deviations. These methods require further evaluation.Trial registrationISRCTN Registry, ISRCTN38581822 (Registered: 02/01/2014).

BackgroundDespite growing numbers of studies reporting the efficacy of complex interventions and their implementation, many studies fail to report information on implementation fidelity or describe how fidelity measures used within the study were developed. This study aimed to develop a fidelity checklist for measuring the implementation fidelity of an early, stroke-specialist vocational rehabilitation intervention (ESSVR) in the RETAKE trial.MethodsTo develop the fidelity measure, previous checklists were reviewed to inform the assessment structure, and core intervention components were extracted from intervention descriptions into a checklist, which was ratified by eight experts in fidelity measurement and complex interventions. Guidance notes were generated to assist with checklist completion. To test the measure, two researchers independently applied the checklist to fifteen stroke survivor intervention case notes using retrospective observational case review. The scoring was assessed for interrater reliability.ResultsA fidelity checklist containing 21 core components and 6 desirable components across 4 stages of intervention delivery was developed with corresponding guidance notes. Interrater reliability of each checklist item ranged from moderate to perfect (Cohen’s kappa 0.69–1).ConclusionsThe resulting checklist to assess implementation fidelity is fit for assessing the delivery of vocational rehabilitation for stroke survivors using retrospective observational case review. The checklist proved its utility as a measure of fidelity and may be used to inform the design of future implementation strategies.Trial registrationISRCTN, ISRCTN12464275. Registered on 13 March 2018.

The contextual fit of a behavior support plan refers to the extent that the procedures of the plan are consistent with the knowledge, values, skills, resources, and administrative support of those who are expected to implement the plan. This study used a concurrent multiple baseline design across four participants to assess the presence of a functional relation between introduction of the Contextual Fit Enhancement Protocol, an intervention designed to improve contextual fit, and (a) an increase in fidelity of support plan implementation and (b) improved student behavior. Results indicate that following implementation of the Contextual Fit Enhancement Protocol, support plan implementation fidelity increased and student problem behavior decreased. In addition, teachers participating in the study rated the contextual fit intervention process as effective and efficient. Limitations and implications for future research, practice, and training are discussed.

Fidelity in school-based child sexual abuse prevention programs: A systematic review

Research suggests that elementary English Learners (ELs) benefit from interactive dual-language vocabulary instruction delivered one-on-one or in small groups. However, there are many barriers to providing this type of instruction to all ELs, including time constraints and bilingual teacher shortages. Thus, there is a high need for innovative, cost, and time effective solutions to support the growing population of ELs in the US. This exploratory case study examined the feasibility and viability of a scripted intervention designed for synchronous remote delivery. Six fourth-grade ELs received 6 weeks of an evidence-based academic vocabulary language curriculum that included one-on-one instruction delivered via Microsoft Teams. A liaison within the school coordinated intervention delivery. Fidelity of Implementation was examined for adherence and dosage. Lessons were recorded and coded using a fidelity checklist. Overall, the remote modality was viable, including intervention procedures and materials. Results revealed that instructor adherence to explicit vocabulary instruction elements was superior (97%-100%) to findings in prior research among face-to-face interventions delivered by classroom teachers. Adherence to reading instruction elements was comparable to prior research. Synchronous remote interventions can enable ELs to receive effective, differentiated instruction from a trained instructor, regardless of school resources.

School-wide positive behavior interventions and supports (SWPBIS) is a school-wide approach to create a safe and positive school climate. SWPBIS is a framework in which core features and procedures need to be adjusted to its specific school context, referred to as contextual fit. Implementing with fidelity is related to positive outcomes such as a decrease of behavioral problems. Therefore, when adapting SWPBIS to the context, fidelity of implementation needs to be assured. At the introduction of SWPBIS in the Netherlands in 2009, several procedures were adapted to the Dutch educational context, and different modalities of supporting schools in implementing SWPBIS emerged. In this study, the Tiered Fidelity Inventory (TFI) and School-Wide Evaluation Tool (SET) were used to assess fidelity of Tier 1 implementation in 117 Dutch schools. The average period of SWPBIS implementation was 2 years 5 months. Results showed that all core features and procedures were present. Mean total scores were 60% for the TFI and 70% for the SET. Most participating schools appeared to have leadership teams, expectations were taught, and acknowledgment provided. Teams had been trained, and discipline data collected. Compared with other features, annual evaluation, data-based decision making, and stakeholder involvement were less well implemented.

The RECETAS project aims to test the Friends in Nature (FIN) intervention in 6 different countries and target populations through 3 pre-post studies (France, Ecuador and Australia) and 3 randomized controlled trials (Finland, Spain and Czech Republic). Given that FIN is a complex intervention implemented and adapted in 6 different socio-economic and cultural contexts, process evaluation is a key element shared by the six studies. This presentation aims to report and discuss how implementation fidelity was structured and the results obtained across sites. A fidelity checklist was created jointly by all involved partners to capture the key components of the intervention. Quantitative data on the degree of implementation of each component were collected at group level for each group undergoing FIN. The checklist comprised the individual components of FIN (interview and empowerment letter), group structure (group size, number of sessions and number of facilitators) and group process in terms of mentoring (in-site visits and learning diary) and group dynamics (empowerment and group climate, nature-based activities, dynamics on loneliness and social connection and continuation of the group). A high degree of fidelity was reported across components and sites, meaning FIN can be adapted and implemented in different contexts while maintaining its core values. Although relevant adaptations were planned before the implementation, assessing fidelity helped us to identify specific challenges that require further adaptation of procedures to certain populations.

ABSTRACTBackgroundImplementation of school‐based health promotion programs requires contextual fit. To strengthen the nutrition education program “Krachtvoer” (ENG: “Power Food”) and learn general lessons about contextual fit, this study examined how the program, the context, and program‐context interactions affected teachers' balancing between implementation fidelity and adaptation.MethodsAs part of a co‐creation process with continuous micro‐process cycles of implementing, measuring, evaluating, and adapting the program, action‐oriented research was conducted during the pilot implementation of program modules by 25 teachers in 32 classes with 635 students. Using observations and interviews, data were collected about indicators of the implementation process, technology, layout, and content aspects of the program, inner and broader school contextual factors including teacher, student, and school characteristics, and interactions between program‐ and context‐related aspects that influence the implementation process.ResultsEven small mismatches between the program and the context affected the implementation process. Differences in the technological savviness of teachers and students, “adaptive management” skills to respond to changing circumstances of teachers, and the maturity and attention span of students were among the many contextual differences in and between schools.Implication for School‐Based Health PromotionSustainability of health promotion programs fitting the context requires continuous and co‐creating efforts from all stakeholders.ConclusionsAction‐oriented research with micro‐process cycles proved appropriate for strengthening the program. However, further research is needed on capacity building among program implementers in balancing fidelity and adaptation.

In this chapter, research on the Fidelity of Implementation of Assessment (FOI-A) for the Battelle Developmental Inventory—Second Edition (BDI-2) across one New England state is used to provide guidance for supervisors and coaches on issues of FOI-A and how specifically to give feedback on the fidelity checklists and how early childhood professionals can use the feedback to improve their practice. Examples of feedback used in the study are provided. The authors share processes and procedures for feedback and coaching of professionals about their FOI-A. This chapter will present an interactive model for directors and team members to collaborate and improve FOI-A for themselves and their teams. Utilizing a reflective supervision model that includes observations protocols and checklists, supervisors and coaches are provided with helpful strategies for providing direct feedback to examiners of the Battelle Developmental Inventory—Second Edition (BDI-2). Positive frameworks and strengths-based approaches are leveraged to improve FOI-A in a nonjudgmental and collaborative learning environment. Finally, specific examples of FOI-A feedback for the BDI-2 that are based on fidelity checklists and fidelity observation protocols are shared.

Shared Decision Making In Cardiology Practice: 15 Month Results of A Multi-Site Study of Decision Aid Implementation

Implementation of Patient-Centered Shared Decision Making for LVAD Candidates: Year 1 Results of a Multi-Site Study

School-wide Positive Behaviour Support uses a Multi-Tiered System of Support to align academic, behavioural, social, and emotional interventions. Tier 3 supports are individualised and intensive and use a function-based approach in their planning and implementation. This chapter has a focus on Tier 3 supports and how they can be applied in schools. The chapter describes the process of functional behavioural assessment (FBA) from assessment to planning development, intervention, and implementation. The authors review the technical requirements of FBA, including tools to assess the quality of behaviour support plans (BSPs), as well as the need for BSPs to be person-centred, team-based, culturally responsive, and socially valid. They review enablers and barriers to implementing Tier 3 supports, including the importance of maintaining and integrating Tier 1 and Tier 2 responses. They discuss the issue of ‘contextual fit’ and the tools that help to assess and monitor the fidelity of implementation. They share practical examples from their work; these include an Australian-developed template to support basic FBA, the use of Prevent-Teach-Reinforce in schools, and the In2School programme, a Tier 3 intervention for school refusal. Recommendations are made for improvement in the implementation of Tier 3 in Australian schools.

Few studies have analyzed the effectiveness of online music professional development (OMPD) on teachers’ pedagogical competencies. We evaluated the effectiveness of an OMPD designed to train kindergarten teachers in a music-and-movement intervention, drawing on the notion of implementation fidelity (i.e., level of accuracy with which an intervention is delivered). In addition, we investigated teachers’ perspectives on the factors that facilitated their learning. After 83 teachers from seven kindergartens took the OMPD, all Kindergarten 2 teachers ( N = 9) were observed implementing the intervention. In this mixed-methods study, we used implementation fidelity checklists completed by teachers and external observers and individual teacher interviews. Findings revealed consistently high implementation fidelity ratings by both teachers and external observers. School support, practice, preparation, sufficient time and space, and reflection were the facilitative factors identified in the interviews. The study highlights the potential of OMPD in fostering the music-specific pedagogical competencies of general classroom teachers.