An mHealth Intervention for Persons with Diabetes Type 2 Based on Acceptance and Commitment Therapy Principles: Examining Treatment Fidelity (Preprint)

Abstract

Background: Internet based interventions are becoming an alternative of treatment aimed to support behavioral changes and several advantages over traditional treatments are reported.New ways of delivering an intervention may result in new challenges regarding monitoring of treatment fidelity which is essential to ensure internal and external validity. Despite of the importance of the theme, only few studies in this field are reported.Objective: To examine treatment fidelity of a smartphone delivered intervention based on Acceptance and Commitment Therapy (ACT) with e-diaries and written situational feedback for persons with Diabetes Mellitus type 2 (DMT2), the recommendations from the Behavior Change Consortium (BCC) established by The National Institutes of Health (NHI) were applied. To analyze fidelity, they recommend five areas to be investigated; design of study, provider training, delivery of treatment, receipt of treatment, and enactment of treatment. In this study these areas were examined based on the analysis of therapists' adherence to the treatment protocol and participants' and therapists' experience with the intervention. Methods:To investigate the therapists' adherence to the treatment protocol 251 written feedback messages were divided in text segments and qualitative thematic analyses were done to examine how ACT and other therapeutic processes were used in the feedback by the therapists. For the therapists' and participants' experience analysis, participants answered a self-reported questionnaire and participated in two interviews. The therapists spontaneously reported their experiences to the researcher responsible for the project. and therapists' experience with the intervention, the five areas of treatment fidelity recommended by NHI BCC were analyzed indicating a high level of treatment fidelity. These results ensure an appropriate level of internal and external validity of the study and reliable intervention results and facilitate a precise replication of this intervention concept. A reliable assessment of therapists' adherence to the smartphone delivered intervention based on ACT was possible due to the coding scheme developed in a previous study.Internet-delivered psychological interventions to support people with chronic conditions are increasingly common. This study supports the results from the previous study which indicated that ACT can reliably be delivered in a written web-based format.