Fidelity of primary care nurses' delivery of a behavioural change intervention enhancing physical activity in patients at risk of cardiovascular disease: an observational study

Heleen Westland, Jaap C A Trappenburg, Marieke J Schuurmans, Michelle H Zonneveld, Carin D Schröder, Heleen Westland, Jaap C A Trappenburg, Marieke J Schuurmans, Michelle H Zonneveld, Carin D Schröder

Abstract

Objective: To evaluate the fidelity of delivery of a nurse-led intervention to enhance physical activity in patients at risk for cardiovascular diseases, the Activate intervention, by assessing: (1) self-reported fidelity of delivery; (2) observed fidelity of delivery; (3) quality of delivery of the Activate intervention and (4) nurses' beliefs about their capability, motivation, confidence and effectiveness towards delivering the Activate intervention, including behavioural change techniques.

Design: An observational study.

Setting: General practices in the Netherlands.

Participants: Primary care nurses (n=20) from 16 general practices.

Primary and secondary outcome measures: Nurses' self-reported fidelity was evaluated using checklists (n=282), and the observed fidelity and quality of delivery were examined using audiorecordings of consultations of the delivery of the Activate intervention (n=42). Nurses' beliefs towards delivering the intervention were assessed using questionnaires (n=72).

Results: The self-reported fidelity was 88.1% and observed fidelity was 85.4%, representing high fidelity. The observed fidelity of applied behavioural change techniques was moderate (75.0%). The observed quality of delivery was sufficient and varied among nurses (mean 2.9; SD 4.4; range 0-4). Nurses' beliefs about their capability, motivation, confidence and effectiveness towards delivering the intervention increased over time.

Conclusions: Nurses delivered most intervention components as intended with sufficient quality. Nurses believed they were capable, motivated and confident to deliver the intervention. They believed the intervention was effective to increase patients' physical activity level. Despite the high fidelity and moderate fidelity of applied behavioural change techniques, the varying quality of delivery within and across nurses might have diluted the effectiveness of the Activate intervention.

Trial registration number: NCT02725203.

Keywords: preventive medicine; primary care; social medicine.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Craig P, Dieppe P, Macintyre S, et al. . Developing and evaluating complex interventions: the new medical Research Council guidance. BMJ 2008;337:a1655. 10.1136/bmj.a1655
    1. Oakley A, Strange V, Bonell C, et al. . Process evaluation in randomised controlled trials of complex interventions. BMJ 2006;332:413–6. 10.1136/bmj.332.7538.413
    1. Moore GF, Audrey S, Barker M, et al. . Process evaluation of complex interventions: medical research council guidance. BMJ 2015;350:h1258. 10.1136/bmj.h1258
    1. Boutron I, Moher D, Altman DG, et al. . Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 2008;148:295–309. 10.7326/0003-4819-148-4-200802190-00008
    1. Nelson MC, Cordray DS, Hulleman CS, et al. . A procedure for assessing intervention fidelity in experiments testing educational and behavioral interventions. J Behav Health Serv Res 2012;39:374–96. 10.1007/s11414-012-9295-x
    1. Bellg AJ, Borrelli B, Resnick B, et al. . Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH behavior change Consortium. Health Psychol 2004;23:443–51. 10.1037/0278-6133.23.5.443
    1. Borrelli B. The assessment, monitoring, and enhancement of treatment fidelity in public health clinical trials. J Public Health Dent 2011;71:S52–63. 10.1111/j.1752-7325.2011.00233.x
    1. Lorencatto F, West R, Bruguera C, et al. . A method for assessing fidelity of delivery of telephone behavioral support for smoking cessation. J Consult Clin Psychol 2014;82:482–91. 10.1037/a0035149
    1. Hardeman W, Michie S, Fanshawe T, et al. . Fidelity of delivery of a physical activity intervention: predictors and consequences. Psychol Health 2008;23:11–24. 10.1080/08870440701615948
    1. Borrelli B, Sepinwall D, Ernst D, et al. . A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research. J Consult Clin Psychol 2005;73:852–60. 10.1037/0022-006X.73.5.852
    1. Westland H, Bos-Touwen ID, Trappenburg JCA, et al. . Unravelling effectiveness of a nurse-led behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: study protocol for a cluster randomised controlled trial. Trials 2017;18:79–94. 10.1186/s13063-017-1823-9
    1. Westland H, Schuurmans MJ, Bos-Touwen ID, et al. . Effectiveness of the nurse-led activate intervention in patients at risk of cardiovascular disease in primary care: a cluster-randomised controlled trial. Eur J Cardiovasc Nurs 2020;19:1474515120919547. 10.1177/1474515120919547
    1. Westland H, Koop Y, Schröder CD, et al. . Nurses’ perceptions towards the delivery and feasibility of a behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: a qualitative study. BMC Fam Pract 2018;19:194. 10.1186/s12875-018-0888-1
    1. Westland H, Sluiter J, te Dorsthorst S, et al. . Patients’ experiences with a behaviour change intervention to enhance physical activity in primary care: A mixed methods study. PLoS One 2019;14:e0212169. 10.1371/journal.pone.0212169
    1. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011;6:42-5908-6-42. 10.1186/1748-5908-6-42
    1. Gearing RE, El-Bassel N, Ghesquiere A, et al. . Major ingredients of fidelity: a review and scientific guide to improving quality of intervention research implementation. Clin Psychol Rev 2011;31:79–88. 10.1016/j.cpr.2010.09.007
    1. Donovan HS, Kwekkeboom KL, Rosenzweig MQ, et al. . Nonspecific effects in psychoeducational intervention research. West J Nurs Res 2009;31:983–98. 10.1177/0193945909338488
    1. Taylor CA, Shaw RL, Dale J, et al. . Enhancing delivery of health behaviour change interventions in primary care: a meta-synthesis of views and experiences of primary care nurses. Patient Educ Couns 2011;85:315–22. 10.1016/j.pec.2010.10.001
    1. Kennedy A, Rogers A, Bowen R, et al. . Implementing, embedding and integrating self-management support tools for people with long-term conditions in primary care nursing: a qualitative study. Int J Nurs Stud 2014;51:1103–13. 10.1016/j.ijnurstu.2013.11.008
    1. Slootmaker SM, Chin A Paw MJM, Schuit AJ, et al. . Concurrent validity of the PAM accelerometer relative to the MTI Actigraph using oxygen consumption as a reference. Scand J Med Sci Sports 2009;19:36–43. 10.1111/j.1600-0838.2007.00740.x
    1. Michie S, Richardson M, Johnston M, et al. . The behavior change technique taxonomy (V1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013;46:81–95. 10.1007/s12160-013-9486-6
    1. Lane C, Huws-Thomas M, Hood K, et al. . Measuring adaptations of motivational interviewing: the development and validation of the behavior change counseling index (BECCI). Patient Educ Couns 2005;56:166–73. 10.1016/j.pec.2004.01.003
    1. Noell GH, Gresham FM, Gansle KA. Does treatment integrity matter? A preliminary investigation of instructional implementation and mathematics performance. J Behav Educ 2002;11:51–67. 10.1023/A:1014385321849
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–74. 10.2307/2529310
    1. Steinijans VW, Diletti E, Bömches B, et al. . Interobserver agreement: Cohen’s kappa coefficient does not necessarily reflect the percentage of patients with congruent classifications. Int J Clin Pharmacol Ther 1997;35:93–5.
    1. French SD, Green SE, Francis JJ, et al. . Evaluation of the fidelity of an interactive face-to-face educational intervention to improve general practitioner management of back pain. BMJ Open 2015;5:e007886. 10.1136/bmjopen-2015-007886
    1. Lorencatto F, West R, Christopherson C, et al. . Assessing fidelity of delivery of smoking cessation behavioural support in practice. Implement Sci 2013;8:40–50. 10.1186/1748-5908-8-40
    1. Sweeney-Magee M, Kale D, Galton S, et al. . Assessing the fidelity of delivery of an intervention to increase attendance at the English stop smoking services. Implement Sci 2016;11:166–77. 10.1186/s13012-016-0498-z
    1. Leventhal H, Friedman MA. Does establishing fidelity of treatment help in understanding treatment efficacy? Comment on Bellg et al. (2004). Health Psychol 2004;23:452–6. 10.1037/0278-6133.23.5.452
    1. Schlosser R. On the importance of being earnest about treatment integrity. Augmentative and Alternative Communication 2002;18:36–44. 10.1080/aac.18.1.36.44
    1. Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol 2008;41:327–50. 10.1007/s10464-008-9165-0
    1. Westland H, Schröder CD, de Wit J, et al. . Self-management support in routine primary care by nurses. Br J Health Psychol 2018;23:88–107. 10.1111/bjhp.12276
    1. Mc Sharry J, Williams SL, Taylor C. Intervention fidelity of a provider delivered walking intervention in primary care: a mixed method study. In Toomey E, 32th conference health psychology across the lifespan: Uniting research, practice and policy. EHPS, Galway, Ireland 2018.

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