Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care

Henna Hasson, Staffan Blomberg, Anna Dunér, Henna Hasson, Staffan Blomberg, Anna Dunér

Abstract

Background: Prior studies measuring fidelity of complex interventions have mainly evaluated adherence, and not taken factors affecting adherence into consideration. A need for studies that clarify the concept of fidelity and the function of factors moderating fidelity has been emphasized. The aim of the study was to systematically evaluate implementation fidelity and possible factors influencing fidelity of a complex care continuum intervention for frail elderly people.

Methods: The intervention was a systematization of the collaboration between a nurse with geriatric expertise situated at the emergency department, the hospital ward staff, and a multi-professional team with a case manager in the municipal care services for older people. Implementation was evaluated between September 2008 and May 2010 with observations of work practices, stakeholder interviews, and document analysis according to a modified version of The Conceptual Framework for Implementation Fidelity.

Results: A total of 16 of the 18 intervention components were to a great extent delivered as planned, while some new components were added to the model. No changes in the frequency or duration of the 18 components were observed, but the dose of the added components varied over time. Changes in fidelity were caused in a complex, interrelated fashion by all the moderating factors in the framework, i.e., context, staff and participant responsiveness, facilitation, recruitment, and complexity.

Discussion: The Conceptual Framework for Implementation Fidelity was empirically useful and included comprehensive measures of factors affecting fidelity. Future studies should focus on developing the framework with regard to how to investigate relationships between the moderating factors and fidelity over time.

Trial registration: ClinicalTrials.gov, NCT01260493.

Figures

Figure 1
Figure 1
Assessment of fidelity and moderating factors in the present study in accordance to the modified version of The Conceptual Framework for Implementation Fidelity (originally from Carroll et al.).

References

    1. Lipsey MW, Cordray DS. Evaluation methods for social intervention. Annu Rev Psychol. 2000;51:345–375. doi: 10.1146/annurev.psych.51.1.345.
    1. Dobson D, Cook TJ. Avoiding type III error in program evaluation: Results from a field experiment. Eval Program Planning. 1980;3:269–276. doi: 10.1016/0149-7189(80)90042-7.
    1. Borrelli B, Sepinwall D, Ernst D, Bellg AJ, Czajkowski S, Breger R, DeFrancesco C, Levesque C, Sharp DL, Ogedegbe G. 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.
    1. Bellg AJ, Borrelli B, Resnick B, Hecht J, Minicucci DS, Ory M, Ogedegbe G, Orwig D, Ernst D, Czajkowski S. Enhancing treatment fidelity in health behavior change studies: Best practices and recommendations from the NIH Behavior Change Consortium. Heal Psychol. 2004;23:443–451.
    1. Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F. Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication 231); 2005.
    1. Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S. A conceptual framework for implementation fidelity. Implement Sci. 2007;2:40. doi: 10.1186/1748-5908-2-40.
    1. Bradley F, Wiles R, Kinmonth AL, Mant D, Gantley M. Development and evaluation of complex interventions in health services research: case study of the Southampton heart integrated care project (SHIP). The SHIP Collaborative Group. BMJ. 1999;318:711–715. doi: 10.1136/bmj.318.7185.711.
    1. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655. doi: 10.1136/bmj.a1655.
    1. Dusenbury L, Brannigan R, Falco M, Hansen WB. A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Heal Educ Res. 2003;18:237–256. doi: 10.1093/her/18.2.237.
    1. Dane AV, Schneider BH. Program integrity in primary and early secondary prevention: are implementation effects out of control? Clin Psychol Rev. 1998;18:23–45. doi: 10.1016/S0272-7358(97)00043-3.
    1. Blakely CH, Mayer JP, Gottschalk RG, Schmitt N, Davidson WS, Roitman DB, Emshoff JG. The fidelity-adaptation debate: Implications for the implementation of public sector social programs. Am J Commun Psychology. 1987;15:253–268.
    1. Becker, Smith J, Tanzman B, Drake RE, Tremblay T. Fidelity of supported employment programs and employment outcomes. Psychiatric Services. 2001;52:834. doi: 10.1176/appi.ps.52.6.834.
    1. Keith RE, Hopp FP, Subramanian U, Wiitala W, Lowery JC. Fidelity of implementation: development and testing of a measure. Implement Sci. 2010;5:99. doi: 10.1186/1748-5908-5-99.
    1. Abbott RD, O'Donnell J, Hawkins JD, Hill KG, Kosterman R, Catalano RF. Changing teaching practices to promote achievement and bonding to school. Am J Orthopsychiatry. 1998;68:542–552.
    1. Hansen WB, Graham JW, Wolkenstein BH, Rohrbach LA. Program integrity as a moderator of prevention program effectiveness: Results for fifth-grade students in the adolescent alcohol prevention trial. Journal of Studies on Alcohol. 1991;52(6):568–579.
    1. Rohrbach LA, Graham JW, Hansen WB. Diffusion of a school-based substance abuse prevention program: Predictors of program implementation. Preventive Med. 1993;22:237–260. doi: 10.1006/pmed.1993.1020.
    1. Mihalic S. The importance of implementation fidelity. Emotional & Behav Disorders Youth. 2004;4:83–86.
    1. McGrew JH, Griss ME. Concurrent and predictive validity of two scales to assess the fidelity of implementation of supported employment. Psychiatric Rehabilitation J. 2005;29:41–47. doi: 10.2975/29.2005.41.47.
    1. Kilbourne AM, Neumann MS, Pincus HA, Bauer MS, Stall R. Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Implement Sci. 2007;2:42. doi: 10.1186/1748-5908-2-42.
    1. Castro FG, Barrera M, Martinez CR. The cultural adaptation of prevention interventions: Resolving tensions between fidelity and fit. Prev Sci. 2004;5:41–45.
    1. Fraser MW, Richman JM, Galinsky MJ. Intervention research: Developing social programs. USA: Oxford University Press; 2009.
    1. Hasson H. Study protocol: Systematic evaluation of implementation fidelity of complex interventions in health and social care. Implement Sci. 2010;5:67. doi: 10.1186/1748-5908-5-67.
    1. Baranowski T, Stables G. Process evaluations of the 5-a-day projects. Health Edu & Behavior. 2000;27:157–166. doi: 10.1177/109019810002700202.
    1. Steckler AB, Linnan L, Israel BA. Process evaluation for public health interventions and research. Jossey-Bass; 2002.
    1. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82:581–629. doi: 10.1111/j.0887-378X.2004.00325.x.
    1. Naleppa MJ, Cagle JG. Treatment Fidelity in Social Work Intervention Research: A Review of Published Studies. Res Soc Work Pract. 2010;20:674. doi: 10.1177/1049731509352088.
    1. Glasgow RE, Lichtenstein E, Marcus AC. Why don't we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. Am J Publ Health. 2003;93:1261. doi: 10.2105/AJPH.93.8.1261.
    1. Noonan RK, Emshoff JG, Mooss A, Armstrong M, Weinberg J, Ball B. Adoption, adaptation, and fidelity of implementation of sexual violence prevention programs. Heal Promot Pract. 2009;10:59S. doi: 10.1177/1524839908329374.
    1. Condelius A, Edberg AK, Jakobsson U, Hallberg IR. Hospital admissions among people 65+ related to multimorbidity, municipal and outpatient care. Arch Gerontol Geriatr. 2008;46:41–55. doi: 10.1016/j.archger.2007.02.005.
    1. Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med. 2007;2:314–323. doi: 10.1002/jhm.228.
    1. Coleman EA, Berenson RA. Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med. 2004;141:533–536.
    1. Dunér A, Blomberg S, Hasson H. Implementing a continuum of care model for older people - results from a Swedish case study. International Journal of Integrated Care. 2011;11:e136.
    1. Ouwens M, Wollersheim H, Hermens R, Hulscher M, Grol R. Integrated care programmes for chronically ill patients: a review of systematic reviews. Int J Qual Health Care. 2005;17:141–146. doi: 10.1093/intqhc/mzi016.
    1. Eklund K, Wilhelmson K. Outcomes of coordinated and integrated interventions targeting frail elderly people: A systematic review of randomised controlled trials. Health & Social Care Commun. 2009;17:447–458. doi: 10.1111/j.1365-2524.2009.00844.x.
    1. Hallberg IR, Kristensson J. Preventive home care of frail older people: a review of recent case management studies. J Clin Nurs. 2004;13:112–120. doi: 10.1111/j.1365-2702.2004.01054.x.
    1. Wilhelmson K, Duner A, Eklund K, Gosman-Hedstrom G, Blomberg S, Hasson H, Gustafsson H, Landahl S, Dahlin-Ivanoff S. Continuum of care for frail elderly people: Design of a randomized controlled study of a multi-professional and multidimensional intervention targeting frail elderly people. BMC Geriatr. 2011;11:24. doi: 10.1186/1471-2318-11-24.
    1. Stemler S. An overview of content analysis. Pract Assess, Res & Eval. 2001;7:137–146.
    1. Martens M, Van Assema P, Paulussen T, Schaalma H, Brug J. Krachtvoer: process evaluation of a Dutch programme for lower vocational schools to promote healthful diet. Heal Educ Res. 2006;21:695. doi: 10.1093/her/cyl082.
    1. Gällstedt M. Working conditions in projects: perceptions of stress and motivation among project team members and project managers. Int J Proj Manag. 2003;21:449–455. doi: 10.1016/S0263-7863(02)00098-4.
    1. Glisson C, Hemmelgarn A. The effects of organizational climate and interorganizational coordination on the quality and outcomes of children's service systems. Child Abuse & Neglect. 1998;22:401–421. doi: 10.1016/S0145-2134(98)00005-2.
    1. Henry WP, Strupp HH, Butler SF, Schacht TE, Binder JL. Effects of training in time-limited dynamic psychotherapy: Changes in therapist behavior. J Consult Clin Psychol. 1993;61:434.
    1. Mowbray CT, Holter MC, Teague GB, Bybee D. Fidelity criteria: Development, measurement, and validation. Am J Eval. 2003;24:315.
    1. Borrelli B. The assessment, monitoring, and enhancement of treatment fidelity in public health clinical trials. J Publ Health Dentistry. 2011;71:S52–S63.
    1. Bouffard JA, Taxman FS, Silverman R. Improving process evaluations of correctional programs by using a comprehensive evaluation methodology. Eval Program Planning. 2003;26:149–161. doi: 10.1016/S0149-7189(03)00010-7.
    1. Bond GR, Evans L, Salyers MP, Williams J, Kim HW. Measurement of Fidelity in Psychiatric Rehabilitation. Ment Heal Serv Res. 2000;2:75–87. doi: 10.1023/A:1010153020697.

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