Abstract
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.
Highlights
IntroductionIntroduction to physical activity guidelinesAssessing motivationAssessing importance and confidence in making healthy lifestyle changes, healthy dietary changes, and/or to increase physical activityDiscussing key elementsDiscussing the importance of low fat and high fibre diets, and about each of the food groupsDiscussing the benefits of physical activity, and the different types of activityAdherence criteria commonly omitted/implemented at a low level across all sessions (i.e. scored 1)Comprehension and retention Recap and assess retention from previous week’s session of informationReview all items at the end of Session 4 Activity diariesRemind participants to complete activity diary in time for Session 3Monitor awareness and reflection of physical activity undertaken, and assess motivation to increase activity levels
Introduction to physical activity guidelinesAssessing motivationAssessing importance and confidence in making healthy lifestyle changes, healthy dietary changes, and/or to increase physical activityDiscussing key elementsDiscussing the importance of low fat and high fibre diets, and about each of the food groupsDiscussing the benefits of physical activity, and the different types of activityAdherence criteria commonly omitted/implemented at a low level across all sessionsComprehension and retention Recap and assess retention from previous week’s session of informationReview all items at the end of Session 4 Activity diariesRemind participants to complete activity diary in time for Session 3Monitor awareness and reflection of physical activity undertaken, and assess motivation to increase activity levels
The present study reports on one such assessment of Living Well Taking Control (LWTC) – a voluntary sector-led, community-based type 2 diabetes education programme that focusses on the prevention and management of the condition
Summary
Introduction to physical activity guidelinesAssessing motivationAssessing importance and confidence in making healthy lifestyle changes, healthy dietary changes, and/or to increase physical activityDiscussing key elementsDiscussing the importance of low fat and high fibre diets, and about each of the food groupsDiscussing the benefits of physical activity, and the different types of activityAdherence criteria commonly omitted/implemented at a low level across all sessions (i.e. scored 1)Comprehension and retention Recap and assess retention from previous week’s session of informationReview all items at the end of Session 4 Activity diariesRemind participants to complete activity diary in time for Session 3Monitor awareness and reflection of physical activity undertaken, and assess motivation to increase activity levels. Voluntary sector agencies play an increasingly important role in the delivery of community-based health promotion and disease management programmes. The quality of these initiatives is a key concern for potential service users, commissioners, partner agencies, and other stakeholders This is partly because voluntary sector agencies are not necessarily subject to the same procedures for quality assurance or the employment of registered professionals as mainstream health service organisations (Baggott, 2013). In this context, research focussing on the fidelity of programme implementation offers a basis for assessing and further enhancing voluntary sector-led practice. The present study reports on one such assessment of Living Well Taking Control (LWTC) – a voluntary sector-led, community-based type 2 diabetes education programme that focusses on the prevention and management of the condition
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