Assessing intervention fidelity in a multi-level, multi-component, multi-site program: the Children’s Healthy Living (CHL) program

Butel, J; Braun, Kathryn L.; Novotny, Rachel; Acosta, Mark; Castro, Rose; Fleming, Travis; Power, Julianne Mary; Nigg, Claudio R.

doi:10.1007/s13142-015-0334-z

Cited by 15 publications

(18 citation statements)

References 17 publications

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“…All three MLMC interventions were grounded in ecological systems theory and applied the social ecological model to the design and implementation of the interventions. Each of the three cases (BHCK, CHL, SoL) have published multiple papers describing design [13,14], formative research [15,16], process evaluation [17,18], and impact findings [19,20,21]. The principal investigators (PIs) of the three interventions have presented and discussed their findings and experiences through a series of five consecutive ISBNPA (International Society of Behavioral Nutrition and Physical Activity) symposia.…”

Section: Methodsmentioning

confidence: 99%

Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity

Gittelsohn

Novotny

Trude

et al. 2018

IJERPH

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Multi-level multi-component (MLMC) strategies have been recommended to prevent and reduce childhood obesity, but results of such trials have been mixed. The present work discusses lessons learned from three recently completed MLMC interventions to inform future research and policy addressing childhood obesity. B’more Healthy Communities for Kids (BHCK), Children’s Healthy Living (CHL), and Health and Local Community (SoL) trials had distinct cultural contexts, global regions, and study designs, but intervened at multiple levels of the socioecological model with strategies that address multiple components of complex food and physical activity environments to prevent childhood obesity. We discuss four common themes: (i) How to engage with community partners and involve them in development of intervention and study design; (ii) build and maintain intervention intensity by creating mutual promotion and reinforcement of the intervention activities across the multiple levels and components; (iii) conduct process evaluation for monitoring, midcourse corrections, and to engage stakeholder groups; and (iv) sustaining MLMC interventions and its effect by developing enduring and systems focused collaborations. The paper expands on each of these themes with specific lessons learned and presents future directions for MLMC trials.

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Section: Methodsmentioning

confidence: 99%

Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity

Gittelsohn

Novotny

Trude

et al. 2018

IJERPH

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“…CHL intervention strategies aimed to empower individuals, families, organizations, communities, and policymakers to reduce the growing prevalence of obesity in the U.S.-affiliated Pacific region, including Alaska, American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and Hawai'i. Obesity among young children in the U.S.-affiliated Pacific jurisdictions was 14% in 2013 and was higher among 6 -8-year-old than 2-5-year-old children (Novotny et al, 2015).…”

Section: The Children's Healthy Living Projectmentioning

confidence: 95%

Implementation strategies and barriers to Native Hawaiian and other Pacific Islanders community interventions: A cross-case study of the Children’s Healthy Living program.

Butel

Braun

Nigg

et al. 2019

Asian American Journal of Psychology

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i at Ma noa Understanding strategies and barriers inherent in Native Hawaiian and Other Pacific Islander communitylevel interventions allows for better community outcomes. Collective efficacy (CE), defined as willingness and ability to work toward a common good, is needed to tailor and implement community-level interventions. Monthly reports from 9 intervention sites participating in the multilevel Children's Healthy Living (CHL) intervention to reduce childhood obesity in the U.S.-affiliated Pacific region were coded for themes related to implementation barriers and supports, using the Collective Efficacy Mechanism of Action Model (CE MAM). As outlined in the CE MAM, CE is strengthened through intervention strategies promoting the 5 CE building blocks-social bonding, social bridging, social leveraging, empowerment, and civic engagement. In total, 4 of the 9 communities exhibited greater success, as indicated by higher intervention dose, and better child outcomes. Thus, themes were compared between the 4 high-dose and 5 low-dose communities. An association between community groups and CE building block strategies was observed, 2 (4) ϭ 50.56, p Ͻ .0001; however, no association between community groups and barriers was observed, 2 (4) ϭ 6.32, p ϭ .18. The interplay of strategies involving all 5 CE building blocks in the cross-case analysis of the CHL intervention indicates that multiple strategies were required to implement the multilevel interventions. The strategies and barriers to implementation identified in this analysis of the CHL intervention highlight methods that may assist communities in the process of implementing complex interventions using the CE MAM, especially as they relate to indigenous groups in the U.S. Pacific region. What is the public significance of this article?Understanding the barriers to intervention implementation that are inherent in community work and finding ways to minimize their impact will allow for better outcomes and may be applicable to other Native Hawaiian and Other Pacific Islander community-organizing endeavors. By examining the strategies used and the barriers encountered by these Children's Healthy Living intervention communities, this analysis illustrates how to better operationalize the Collective Efficacy Mechanism of Action Model. This understanding may assist program developers, interventionists, and community groups to develop a process to follow the successful strategies of high-dose communities and limit the barriers commonly seen in low-dose communities.

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“…However, despite the importance of implementation fidelity evaluation, first, there is currently no framework explicitly establishing either a set of procedures or specific requirements to guide the evaluation of the fidelity of an implementation strategy [ 4 , 14 ]. And second, likely linked to this first issue, under-reporting of fidelity of implementation strategies is the rule rather than the exception in the implementation research literature [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Fidelity evaluation of the compared procedures for conducting the PVS-PREDIAPS implementation strategy to optimize diabetes prevention in primary care

et al. 2021

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Background Assessing the fidelity of an implementation strategy is important to understand why and how the strategy influences the uptake of evidence-based interventions. The present study aims to assess the fidelity of the two procedures for engaging primary care (PC) professionals and for the deployment of an implementation strategy for optimizing type 2 diabetes prevention in routine PC within the PREDIAPS randomized cluster implementation trial. Method We conducted a mixed-method fidelity evaluation study of the PVS-PREDIAPS implementation strategy. Nine PC centers from the Basque Health Service (Osakidetza) were allocated to two different procedures to engage physicians and nurses and deploy a implementation strategy to model and adapt the clinical intervention and its implementation to their specific contexts: a Global procedure, promoting the cooperation of all healthcare professionals from the beginning; or a Sequential procedure, centered first on nurses who then pursued the pragmatic cooperation of physicians. Process indicators of the delivery and receipt of implementation strategy actions, documented modifications to the planned implementation strategy, and a structured group interview with centers’ leaders were all used to assess the following components of fidelity: adherence, dose, quality of delivery, professionals’ responsiveness and program differentiation. Results Generally, the procedures compared for professionals engagement and deployment of the implementation strategy were carried out with the planned differentiation. Nonetheless, some unexpected between-group differences were observed, the initial rate of collaboration of nurses being higher in the Sequential (93%) than in the Global (67%) groups. Exposure rate to the programed implementation actions (% of hours received out of those delivered) were similar in both groups by professional category, with nurses (86%) having a higher rate of exposure than physicians (75%). Professionals identified half of the planned discrete strategies and their rating of strategies’ perceived usefulness was overwhelmingly positive, with few differences between Sequential and Global centers. Conclusions The PVS-PREDIAPS implementation strategy has been implemented with high fidelity and minor unplanned reactive modifications. Professionals’ exposure to the implementation strategy was high in both groups. The centers’ organizational context (i.e., work overload) led to small mismatches between groups in participation and exposure of professionals to implementation actions. Trial registration Clinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017.

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Assessing intervention fidelity in a multi-level, multi-component, multi-site program: the Children’s Healthy Living (CHL) program

Cited by 15 publications

References 17 publications

Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity

Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity

Implementation strategies and barriers to Native Hawaiian and other Pacific Islanders community interventions: A cross-case study of the Children’s Healthy Living program.

Fidelity evaluation of the compared procedures for conducting the PVS-PREDIAPS implementation strategy to optimize diabetes prevention in primary care

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