This article describes a measure developed to assess fidelity of working with the Boston University approach to Psychiatric Rehabilitation (BPR) in Dutch mental health care. The instrument is intended to measure and improve BPR adherence and clinician competence on an individual level and within individual rehabilitation processes. https://www.ncbi.nlm.nih.gov/pubmed/28771017
DOCUMENT
Risk assessment instruments are widely used to predict risk of adverse outcomes, such as violence or victimization, and to allocate resources for managing these risks among individuals involved in criminal justice and forensic mental health services. For risk assessment instruments to reach their full potential, they must be implemented with fidelity. A lack of information on administration fidelity hinders transparency about the implementation quality, as well as the interpretation of negative or inconclusive findings from predictive validity studies. The present study focuses on adherence, a dimension of fidelity. Adherence denotes the extent to which the risk assessment is completed according to the instrument’s guidelines. We developed an adherence measure, tailored to the ShortTerm Assessment of Risk and Treatability: Adolescent Version (START:AV), an evidence-based risk assessment instrument for adolescents. With the START:AV Adherence Rating Scale, we explored the degree to which 11 key features of the instrument were adhered to in 306 START:AVs forms, completed by 17 different evaluators in a Dutch residential youth care facility over a two-year period. Good to excellent interrater reliability was found for all adherence items. We identified differences in adherence scores on the various START:AV features, as well as significant improvement in adherence for those who attended a START:AV refresher workshop. Outcomes of risk assessment instruments potentially impact decision-making, for example, whether a youth’s secure placement should be extended. Therefore, we recommend fidelity monitoring to ensure the risk assessment practice was delivered as intended.
DOCUMENT
The TOP program is a fully implemented responsive parenting intervention for very preterm born infants. Fidelity monitoring of interventions is important for preserving program adherence, impact outcomes and to make evidence-based adaptations. The aim of this study was to develop a fidelity tool for the TOP program following an iterative and co-creative process and subsequently evaluate the reliability of the tool. Three consecutive phases were carried out. Phase I: Initial development and pilot testing two methods namely self-report and video based observation. Phase II: Adaptations and refinements. Phase III: Evaluation of the psychometric properties of the tool based on 20 intervention videos rated by three experts.The interrater reliability of the adherence and competence subscales was good (ICC.81 to .84) and varied from moderate to excellent for specific items (ICC between .51 and .98). The FITT displayed a high correlation (Spearman’s rho.79 to.82) between the subscales and total impression item. The co-creative and iterative process resulted in a clinical useful and reliable tool for evaluating fidelity in the TOP program. This study offers insights in the practical steps in the development of a fidelity assessment tool which can be used by other intervention developers.
MULTIFILE
BACKGROUND: Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary settings and the relationship with changes in patients' health behavior.METHODS: This study used longitudinal data from the nationwide implementation of an evidence-informed physical activity promotion program in Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled in by involved professionals (n = ± 70). Higher fidelity scores indicate a more complete implementation of the program's core components. A hierarchical cluster analysis was conducted on the implementation fidelity scores of 17 organizations at three different time points. Quantitative and qualitative data were used to explore organizational and professional differences between identified trajectories. Regression analyses were conducted to determine differences in patient outcomes.RESULTS: Three trajectories were identified as the following: 'stable high fidelity' (n = 9), 'moderate and improving fidelity' (n = 6), and 'unstable fidelity' (n = 2). The stable high fidelity organizations were generally smaller, started earlier, and implemented the program in a more structured way compared to moderate and improving fidelity organizations. At the implementation period's start and end, support from physicians and physiotherapists, professionals' appreciation, and program compatibility were rated more positively by professionals working in stable high fidelity organizations as compared to the moderate and improving fidelity organizations (p < .05). Qualitative data showed that the stable high fidelity organizations had often an explicit vision and strategy about the implementation of the program. Intriguingly, the trajectories were not associated with patients' self-reported physical activity outcomes (adjusted model β = - 651.6, t(613) = - 1032, p = .303).CONCLUSIONS: Differences in organizational-level implementation fidelity trajectories did not result in outcome differences at patient-level. This suggests that an effective implementation fidelity trajectory is contingent on the local organization's conditions. More specifically, achieving stable high implementation fidelity required the management of tensions: realizing a localized change vision, while safeguarding the program's standardized core components and engaging the scarce physicians throughout the process. When scaling up evidence-informed health promotion programs, we propose to tailor the management of implementation tensions to local organizations' starting position, size, and circumstances.TRIAL REGISTRATION: The Netherlands National Trial Register NTR3961 . Registered 18 April 2013.
LINK
Competent delivery of interventions in child and youth social care is important, due to the direct effect on client outcomes. This is acknowledged in evidence-based interventions (EBI) when, post-training, continued support is available to ensure competent delivery of the intervention. In addition to EBI, practice-based interventions (PBI) are used in the Netherlands. The current paper discusses to what extent competent delivery of PBI can be influenced by introducing supervision for professionals. This study used a mixed-method design: (1) A small-n study consisting of six participants in a non-concurrent multiple baseline design (MBL). Professionals were asked to record conversations with clients during a baseline period (without supervision) and an intervention period (with supervision). Visual inspection, the non-overlap of all pairs (NAP), and the Combinatorial Inference Technique (CIT) scores were calculated. (2) Qualitative interviews with the six participants, two supervisors, and one lead supervisor focused on the feasibility of the supervision. Four of six professionals showed improvement in treatment fidelity or one of its sub-scales. Had all participants shown progress, this could have been interpreted as an indication that targeted support of professionals contributes to increasing treatment integrity. Interviews have shown that supervision increased the professionals’ enthusiasm, self-confidence, and awareness of working with the core components of the intervention. The study has shown that supervision can be created for PBI and that this stimulates professionals to work with the core components of the intervention. The heterogeneous findings on intervention fidelity can be the result of supervision being newly introduced.
DOCUMENT
Abstract Summary: Program fidelity instruments are a key ingredient for clinical supervision and implementation as well as effectiveness studies. This study examines the factor structure of the Functional Family Parole services Global Rating Measure (FFP-GRM); the program fidelity instrument of Functional Family Parole services for case management in youth parole, child protection and child welfare services. Between October 2012 and February 2015, program fidelity was measured with the FFP-GRM by Functional Family Parole supervisors. Confirmatory factor analysis was performed on 380 cases and internal consistency reliability coefficients were calculated. Findings: Confirmatory factor analyses showed that the 33-item and four-factor model of the FFP-GRM achieved a good fit to the data. Internal validity testing results showed that subscale Cronbach’s a ranged between .82 and .90. Applications: Findings affirm a good fit to the data and a good-to-excellent internal consistency of the FFP-GRM, which is considered sufficient to justify its use. The results are discussed with regard to the use of fidelity instruments for both clinical and research purposes.
DOCUMENT
In this paper, we present a framework for gamified motor learning through the use of a serious game and high-fidelity motion capture sensors. Our implementation features an Inertial Measurement Unit and a set of Force Plates in order to obtain real-time, high-frequency measurements of patients' core movements and centre of pressure displacement during physical rehabilitation sessions. The aforementioned signals enable two mechanisms, namely a) a game avatar controlled through patient motor skills and b) a rich data stream for post-game motor performance analysis. Our main contribution is a fine-grained processing pipeline for sensor signals, enabling the extraction of a reliable and accurate mapping between patient motor movements, in-game avatar controls and overall motor performance. Moreover, we discuss the potential of this framework towards the implementation of personalised therapeutic sessions and present a pilot study conducted in that direction.
LINK
Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
DOCUMENT
New immersive technologies and COVID lockdowns increase the attention for Virtual Reality Pornography (VRP). In this study, heterosexual women were interviewed about the effect of realism in VRP, using a new VRP Role-framework based on six dimensions. Results showed that VRP evokes strong negative and positive emotions. Different types of realism evoked confusion around fidelity and pornography and triggered different relationship boundaries, roles, and rules. Feelings of betrayal and fidelity seemed less when the partner experiences 360° recorded VRP (VR-type-dimension) alone (companion-dimension). Acceptance and confusion appear high around shared computer-generated experiences with control over avatars (interactive-dimension) that look like the self (resemblance-dimension). Feelings of doubt and betrayal seem high when the partner experiences VRP with strangers using realistic-looking avatars (realism-dimension) that resemble (well)known persons or the partner. This study helps companies explore ways to improve VRP content while considering ethical questions society raises concerning VRP’s impact on relationships.
LINK
Background In a large randomized trial, Utrecht PROactive Frailty Intervention Trial (U‐PROFIT), we evaluated the effectiveness of an integrated program on the preservation of daily functioning in older people in primary care that consisted of a frailty identification tool and a multicomponent nurse‐led care program. Examination of treatment fidelity is critical to successful translation of evidence‐based interventions into practice. Aims To assess treatment delivery, dose and content of nursing care delivered within the nurse‐led care program, and to explore if the delivery may have influenced the trial results. Methods A mixed‐methods study was conducted. Type and dose of nursing care were collected during the trial. Shortly after the trial, a focus group with nurses was conducted to explore reasons for the observed differences between the type and dose of nursing care delivered. Results A total of 835 older persons were included in the nurse‐led care program. The mean age was 75 years, 64% were female and 53.5% were living alone. The most frequent self‐reported conditions were loneliness (60.8%) and cognitive problems (59.4%). One‐third of the patients with a geriatric condition received an additional assessment (e.g., Mini‐Mental State Examination), and the majority of these patients received at least one nurse intervention (>85%). Most nursing care was delivered to patients at risk of falling and to those with urinary incontinence. Patients with nutrition problems seldom received nursing interventions. The nurses explained that differences in type and dose were influenced by the preference of the patient, the type of geriatric problem, and the time required to apply a nurse intervention. Linking Evidence to Action All intervention components were delivered; however, differences were observed in the type and dose of nursing care delivered across geriatric conditions. The findings better explain the treatment fidelity and suggest that there is room for improvement that may result in more beneficial patient outcomes.
LINK
