Abstract
Treatment fidelity is associated with improvement in research outcomes and increased confidence in significant findings. However, few studies report on recommended areas of treatment fidelity (i.e., study design, training, treatment delivery, treatment receipt, and treatment enactment), leaving a dearth of information about implementation components that contributed to a study’s success. Without such information, it is difficult for researchers to correctly assess previous findings and for practitioners to correctly implement findings into practice. Thus, it is crucial that studies assess both treatment fidelity and applicability of treatment fidelity findings. We report measures of treatment fidelity in a randomized controlled trial of an intervention promoting colonoscopy in at-risk relatives of colorectal cancer (CRC) patients. We describe assessments related to both treatment delivery and treatment receipt. We conducted separate ANCOVAs to model the change in each of the treatment receipt variables, comparing the two intervention arms. Compared with the control group, the intervention group had significantly greater improvements in CRC knowledge (f = 17.46, p < .0001), perceptions about susceptibility (f = 15.08, p = .0002), response efficacy (f = 7.46, p = .0076), self-efficacy (f = 8.16, p = .0053), and reduced decisional uncertainty (f = 19.59, p < .0001) from baseline to 1-month follow-up. Overall, our study adhered to most of the best-practice guidelines for behavioral intervention fidelity. This demonstrates that our intervention was delivered as intended and positively affected the cognitive processes that are purported to be predictive of adherent behavioral outcomes.
Highlights
Treatment fidelity is defined as “the ongoing assessment, monitoring, and enhancement of the reliability and internal validity of a study” (Borrelli, 2011, p.1)
This article aims to address both the identified benefits and the potential limitations to treatment fidelity reporting by examining treatment fidelity in the context of the Family Colorectal Cancer Awareness and Risk Education (Family CARE) Project, a randomized controlled trial of an innovative telehealth intervention that aimed to improve colonoscopy uptake in individuals considered to be at intermediate risk of familial colorectal cancer (CRC)
CARE was a randomized controlled trial investigating whether a personalized, remote, theoretically based riskassessment, and counseling intervention was more effective than a mailed, low-intensity targeted print message delivered to individuals who are considered at intermediate familial risk for CRC
Summary
Treatment fidelity is defined as “the ongoing assessment, monitoring, and enhancement of the reliability and internal validity of a study” (Borrelli, 2011, p.1). Adherence to and reporting of treatment fidelity may seem like obvious tasks in any study, yet they are rarely published in relation to specific behavioral intervention trials (Resnick et al, 2005). Monitoring and reporting treatment fidelity assure scientific transparency in a way that facilitates reproducibility, as it both reports on and appraises study process methods. Treatment fidelity measures can be used to facilitate theoretical testing, to provide an outline for research dissemination in clinical practice, and to reduce random and unintended variability (Bellg et al, 2004). The 2004 National Institutes of Health (NIH) Behavior Change Consortium recommends five areas of treatment fidelity best practices: study design, training, treatment
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