Intervention Fidelity: A Necessary Aspect of Intervention Effectiveness Studies

Sharon A. Gutman, PhD, OTR, FAOTA, is Editorin-Chief, American Journal of Occupational Therapy, and Associate Professor, Columbia University, Programs in Occupational Therapy, New York; ajoteditor@aota.org In a recent editorial, we highlighted information commonly absent from manuscripts that report intervention effectiveness (Gutman & Murphy, 2012). One critical element often missing from manuscripts is a discussion of intervention fidelity, which is the extent to which the intervention is delivered as it was intended (Gearing et al., 2011). To assess fidelity, researchers need to determine at the study design stage the methods they will use to assess and monitor the reliability and validity of the intervention (Bellg et al., 2004; Borrelli, 2011). Reporting of fidelity methods in the published product is crucial to allow readers to judge the quality of the study and replicate it and to assist the intervention developers in understanding how various factors may have influenced the outcome of their study. The Consolidated Standards of Reporting Trials (CONSORT) guidelines (Altman et al., 2001), the criteria now required by most medical journals for reporting clinical trials, have been expanded to include reporting of intervention fidelity in nonpharmacological trials (Boutron, Moher, Altman, Schulz, & Ravaud, 2008). The expanded criteria for reporting offer detailed guidance on how to report this additional information. Because fidelity methods are infrequently and inconsistently reported in journals, our intent in this editorial is to discuss the five basic components of intervention fidelity (Bellg et al., 2004; Borrelli, 2011; Gearing et al., 2011): 1. Intervention design 2. Training of providers 3. Intervention delivery 4. Receipt of intervention 5. Enactment of skills gained from the intervention.