Examining Fidelity of Web-based Acceptance and Commitment Interventions for Women with Chronic Widespread Pain

Abstract

Objectives. To examine the protocol adherence to the theoretical background of Acceptance and Commitment Therapy (ACT) in a RCT of a web-based intervention including e-diaries and written personalized feedback delivered via smartphone for persons with chronic widespread pain.Methods. The data consisted of 790 written feedback. A qualitative descriptive design on how ACT and other therapeutic processes were used in the feedback which was applied. The analysis was done with a feedback coding scheme developed employing a combination of an inductive and deductive approach.Results. The coded feedback messages reflected five of the six main ACT processes in addition to communication and motivation strategies. The degree of inter-rater reliability between the researchers coding the feedback, measured by Cohen’s kappa, was 0.790.Conclusions. Based on the level of adherence to ACT-principles the treatment integrity can be judged as high. The developed coding scheme can serve as a basis for coding written therapeutic feedback and thereby serve as a tool for a reliable assessment of the treatment fidelity in ACT based interventions delivered by internet.Practice Implications. Internet-delivered psychological interventions to support people with chronic conditions are increasingly common. Such interventions can be seen as person-centered therapeutic approaches. This study indicates that ACT can reliably be delivered in a written web-based format.