Abstract
BackgroundUntil now, there is no clear overview of how fidelity is assessed in school-based obesity prevention programmes. In order to move the field of obesity prevention programmes forward, the current review aimed to 1) identify which fidelity components have been measured in school-based obesity prevention programmes; 2) identify how fidelity components have been measured; and 3) score the quality of these methods.MethodsStudies published between January 2001–October 2017 were selected from searches in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library and ERIC. We included studies examining the fidelity of obesity prevention programmes (nutrition and/or physical activity and/or sitting) at school (children aged 4–18 year) measuring at least one component of implementation fidelity. A data extraction was performed to identify which and how fidelity components were measured. Thereafter, a quality assessment was performed to score the quality of these methods. We scored each fidelity component on 7 quality criteria. Each fidelity component was rated high (> 75% positive), moderate (50–75%) or low (< 50%).ResultsOf the 26,294 retrieved articles, 73 articles reporting on 63 different studies were included in this review. In 17 studies a process evaluation was based on a theoretical framework. In total, 120 fidelity components were measured across studies: dose was measured most often (N = 50), followed by responsiveness (N = 36), adherence (N = 26) and quality of delivery (N = 8). There was substantial variability in how fidelity components were defined as well as how they were measured. Most common methods were observations, logbooks and questionnaires targeting teachers. The quality assessment scores ranged from 0 to 86%; most fidelity components scored low quality (n = 77).ConclusionsThere is no consensus on the operationalisation of concepts and methods used for assessing fidelity in school-based obesity prevention programmes and the quality of methods used is weak. As a result, we call for more consensus on the concepts and clear reporting on the methods employed for measurements of fidelity to increase the quality of fidelity measurements. Moreover, researchers should focus on the relation between fidelity and programme outcomes and determine to what extent adaptations to programmes have been made, whilst still being effective.
Highlights
Until now, there is no clear overview of how fidelity is assessed in school-based obesity prevention programmes
In order to move the field of obesity prevention programmes forward, we reviewed the literature to identify the current methods used to operationalise, measure and report measures of fidelity
Framework or models were used; Key process evaluation components defined by Steckler and Linnan, Concepts in process evaluations by Baranowski and Stables, Conceptual framework of process evaluations by Mcgraw, How to guide for developing a process evaluation by Saunders, Logic model by Scheirer, RE-AIM framework by Glasgow, Probabilistic mechanistic model of programme delivery by Baranowski and Jago, Taxonomy of outcomes for implementation research by Proctor and Theory of diffusion of innovations by Rogers
Summary
There is no clear overview of how fidelity is assessed in school-based obesity prevention programmes. To combat the worldwide childhood overweight and obesity epidemic, a large variety of healthy eating and physical activity promotion programmes targeting youth have been developed [1]. Schools are regarded as a suitable setting for obesity prevention programmes, as they provide access to almost all children, regardless of their ethnicity or socio economic status [2]. School-based obesity prevention programmes that target healthy eating, physical activity and sedentary behaviour seem promising in reducing or preventing overweight and obesity among children [1, 3, 4]. When those evidence-based programmes are implemented in real world settings, their effectiveness is often disappointing [5]. A better understanding of implementation processes is important to determine if and when disappointing effects can be ascribed to programme failure
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