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Fidelity scorecard: evaluation of a caregiver‐delivered symptom management intervention
Author(s) -
Frambes Dawn,
Lehto Rebecca,
Sikorskii Alla,
Tesnjak Irena,
Given Barbara,
Wyatt Gwen
Publication year - 2017
Publication title -
journal of advanced nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.948
H-Index - 155
eISSN - 1365-2648
pISSN - 0309-2402
DOI - 10.1111/jan.13266
Subject(s) - balanced scorecard , fidelity , intervention (counseling) , nursing assessment , medicine , psychology , medline , physical therapy , nursing , computer science , process management , business , political science , telecommunications , law
Abstract Aim To evaluate and quantify the intervention fidelity of a symptom management protocol through implementation of a scorecard, using an exemplar study of caregiver‐delivered reflexology for people with breast cancer. Background Studies on caregiver‐delivered symptom management interventions seldom include adequate information on protocol fidelity, contributing to potentially suboptimal provision of the therapeutic intervention, hindering reproducibility and generalizability of the results. Design Fidelity assessment of a 4‐week intervention protocol in a randomized controlled trial ( RCT ) with data collection between 2012 ‐ 2016. Methods The National Institutes of Health Behaviour Change Consortium ( NIH ‐ BCC ) conceptual model for intervention fidelity guided the study. The five NIH ‐ BCC fidelity elements are: (1) dose; (2) provider training; (3) intervention delivery; (4) intervention receipt; and (5) enactment. To illustrate the elements, an intervention protocol was deconstructed and each element quantified using a newly developed fidelity scorecard. Results Mean scores and frequency distributions were derived for the scorecard elements. For dose, the mean number of sessions was 4·4, 96% used the correct intervention duration and 29% had 4 weeks with at least one session. Provider training was achieved at 80% of the maximum score, intervention delivery was 96%, intervention receipt was 99% and enactment indicated moderate adoption at 3·8 sessions per patient. The sample mean score was 15·4 out of 16, indicating the high overall fidelity. Conclusion Research findings that include description of how fidelity is both addressed and evaluated are necessary for clinical translation. Clinicians can confidently recommend symptom management strategies to patients and caregivers when fidelity standards are explicitly reported and measured.