Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care

Abstract

BackgroundPrior studies measuring fidelity of complex interventions have mainly evaluated adherence, and not taken factors affecting adherence into consideration. A need for studies that clarify the concept of fidelity and the function of factors moderating fidelity has been emphasized. The aim of the study was to systematically evaluate implementation fidelity and possible factors influencing fidelity of a complex care continuum intervention for frail elderly people.MethodsThe intervention was a systematization of the collaboration between a nurse with geriatric expertise situated at the emergency department, the hospital ward staff, and a multi-professional team with a case manager in the municipal care services for older people. Implementation was evaluated between September 2008 and May 2010 with observations of work practices, stakeholder interviews, and document analysis according to a modified version of The Conceptual Framework for Implementation Fidelity.ResultsA total of 16 of the 18 intervention components were to a great extent delivered as planned, while some new components were added to the model. No changes in the frequency or duration of the 18 components were observed, but the dose of the added components varied over time. Changes in fidelity were caused in a complex, interrelated fashion by all the moderating factors in the framework, i.e., context, staff and participant responsiveness, facilitation, recruitment, and complexity.DiscussionThe Conceptual Framework for Implementation Fidelity was empirically useful and included comprehensive measures of factors affecting fidelity. Future studies should focus on developing the framework with regard to how to investigate relationships between the moderating factors and fidelity over time.Trial registrationClinicalTrials.gov, NCT01260493.

A Hybrid Process Fidelity Assessment in a Home-Based Randomized Clinical Trial

“…In our qualitative analysis, we retrieved relevant information from interviews with the study nurses regarding fidelity that addressed overall levels of competence. Similar to other HHC studies we found that implementation fidelity was influenced by the nurses’ commitment to the study (Hasson, Blomberg, & Dunér, 2012; Stijnen, Jansen, Duimel-Peeters, & Vrijhoef, 2014). Specifically, in this study nurses appeared committed to helping patients effectively adjust to living with their catheters, as well as their ability to execute the intervention protocol.…”

Measuring academic research impact: creating a citation profile using the conceptual framework for implementation fidelity as a case study

“…The citation frequency within these studies, which might be considered to demonstrate high impact of the key paper, ranged from three to as many as 14 in peer-reviewed studies (Hasson et al 2012) and 17 in academic dissertations (with their longer word count) (Rice 2011). Primary research studies published in peer-reviewed journals were the principal publication type across all levels of impact.…”

Evaluation of the Project P.A.T.H.S. in Mainland China: Findings Based on Student Diaries

“…For instance, Siu, Chan, Poon, Chui, and Chan (2007) used the participants' diaries to monitor their self-management behaviors and changes in people with chronic illness after participating in a 6-week program. Hasson, Blomberg, and Dunér (2012) also used diary data to investigate the implementation fidelity and its moderating factors of a complex care intervention for elderly people.…”