Abstract
This manuscript describes the development and the preliminary evaluation of a fidelity instrument for the Program for Encouraging Active and Rewarding Lives (PEARLS), an evidence-based depression care management (DCM) program. The objective of the study was to find an effective, practical, multidimensional approach to measure fidelity of PEARLS programs to the original, research-driven PEARLS protocol in order to inform program implementation at various settings nationwide. We conducted key informant interviews with PEARLS stakeholders, and held focus groups with former PEARLS clients, to identify core program components. These components were then ranked using a Q-sort process, and incorporated into a brief instrument. We tested the instrument at two time points with PEARLS counselors, other DCM program counselors, and non-DCM program counselors (n = 56) in six states. Known-groups method was used to compare findings from PEARLS programs, other DCM programs, and non-DCM programs. We asked supervisors of the counselors to complete the fidelity instrument on behalf of their counselors to affirm the validity of the results. We examined the association of PEARLS program fidelity with individual client outcomes. Program for Encouraging Active and Rewarding Lives providers reported the highest fidelity scores compared to DCM program providers and non-DCM program providers. The sample size was too small to yield significant results on the comparison between counselor experience and fidelity. Scores varied between PEARLS counselors and their supervisors. PEARLS program fidelity was not significantly correlated with client outcomes, suggesting that other implementation factors may have influenced the outcomes and/or that the instrument needs refinement. Our findings suggest that providers may be able to use the instrument to assess PEARLS program fidelity in various settings across the country. However, more rigorous research is needed to evaluate instrument effectiveness.
Highlights
The Program to Encourage Active and Rewarding Lives (PEARLS) was developed in the late 1990s by the University of Washington Health Promotion Research Center, in collaboration with our local Area Agency on Aging and a network of senior centers
We examined the association of PEARLS program fidelity with individual client outcomes
Program for Encouraging Active and Rewarding Lives providers reported the highest fidelity scores compared to depression care management (DCM) program providers and non-DCM program providers
Summary
The Program to Encourage Active and Rewarding Lives (PEARLS) was developed in the late 1990s by the University of Washington Health Promotion Research Center, in collaboration with our local Area Agency on Aging and a network of senior centers. PEARLS is a depression care management (DCM) program using the Chronic Care model [1]. PEARLS includes active screening for depression, using a trained depression care manager, a team approach, stepped care, and built-in follow-up. PEARLS is a participant-driven program, aimed at teaching individuals effective skills to manage their lives when they get overwhelmed. Nurses, social workers, and other front-line staff at community-based aging and social service agencies are trained as PEARLS counselors and work with participants, teaching them problem-solving treatment methods in combination with behavioral activation techniques
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