Abstract
Nurses play an important role in promoting positive childhood development via early interventions intended to support parenting. Despite recognizing the need to deliver vital parenting programs, monitoring fidelity has largely been ignored. Fidelity refers to the degree to which healthcare programs follow a well-defined set of criteria specifically designed for a particular program model. With increasing demands for early intervention programs to be delivered by non-specialists, rigorous yet pragmatic strategies for maintaining fidelity are needed. This paper describes the step-by-step development and evaluation of a program fidelity measure, using the Attachment and Child Health (ATTACH™) parenting program as an exemplar. The overall quality index for program delivery varied between “very good” to “excellent,” with a mean of 4.3/5. Development of checklists like the ATTACH™ fidelity assessment checklist enables the systematic evaluation of program delivery and identification of therapeutic components that enable targeted efforts at improvement. In future, research should examine links between program fidelity and targeted outcomes to ascertain if increased fidelity scores yield more favorable effects of parenting programs.
Highlights
Parents influence children’s affective and cognitive development, with lifelong impacts [1, 2]
This paper describes how to develop and conduct an evaluation of a Fidelity Checklist Development program fidelity checklist, including the step-by-step developmental process our research team used for the Attachment and Child Health (ATTACHTM) parenting program
While overall fidelity of program delivery was only rated in a few parenting programs and mostly based on content validity [14, 55, 57], we created an overall quality index rating from psycho-educational intervention fidelity assessment based on both content and process elements [66, 70, 76,77,78]
Summary
Parents influence children’s affective and cognitive development, with lifelong impacts [1, 2]. Despite recognizing the need to deliver vital parenting programs, monitoring fidelity has been historically ignored [5, 6]. Defining and operationalizing program fidelity for parenting programs is difficult due to their interactive and dynamic nature [10, 11]. Attempts by program developers to assure adherence to their programs include the creation of training and protocol manuals, but these alone may not be sufficient to ensure fidelity of implementation [8, 12]. With increased demands for early intervention to be widely delivered by non-specialists, rigorous yet pragmatic strategies for maintaining program fidelity are needed. In contrast to drug trials, systematic evaluation of program fidelity of psycho-educational programs, such as parenting programs, is more difficult due to the dynamic and often highly individualized interactions between facilitator and parent [20, 21]. Facilitators need to be assessed on whether they delivered the program by using judgment and discretion appropriately
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