Implementation fidelity of an Integrated Healthy Lifestyle Service: a process evaluation

Abstract

Aims: The current study aimed to evaluate implementation fidelity of an Integrated Healthy Lifestyle Service (IHLS). Methods: A pragmatic sample of 28 individual interviews and 11 focus groups were conducted. This resulted in a total of 81 (22 male) individuals comprising key stakeholders (n = 18), as well as intervention staff across senior management (n = 4), team lead (n = 14) and practitioner (n = 11) roles, and intervention clients (n = 34). Results: A mixed degree of implementation fidelity was demonstrated throughout the five a priori fidelity domains of study design, provider training, intervention delivery, intervention receipt, and enactment. Stakeholders, staff and clients alike noted a high degree of intervention receipt across all services offered. Contrastingly, practitioners noted that they received minimal formal operational, data systems, clinical, and curriculum training as well as a lack of personal development opportunities. Consequently, practitioners reported low confidence in delivering sessions and collecting and analysing any data. A top-down approach to information dissemination within the service was also noted among practitioners which affected motivation and overall team morale. Conclusion: Results can be used to conceptualise best practices as a process to further strengthen the design, delivery and recruitment strategies of the IHLS.

Effect of a needs-based model of care on the characteristics of healthcare services in England: the i-THRIVE National Implementation Programme

“…Training activities and attendance at both i-THRIVE Academy and Community of Practice events were reported among implementation sites, and staff from implementation sites exhibited knowledge of THRIVE principles. Continued engagement of staff will likely be important for the integration of THRIVE, and formal assessments or competency checks may be useful to monitor THRIVE delivery (Sanders et al, 2022). In addition to educational activities, several of the implementation strategies used by the NIP, including site diagnostics activities, coaching and support, and involving key partners were found to have positive results at least 75% of the time in a recent review (Ashcraft et al, 2024) Implementation research generates critical evidence for selecting effective strategies for health system transformation (Ashcraft et al, 2024).…”

“…The evaluation could include several outcome metrics, such as acceptability, feasibility, fidelity or cost (Smith and Hasan, 2020). Fidelity is a particularly important metric, as it helps to determine if observed effects can be attributed to the intervention of interest; poor implementation may explain cases with no observed effects (Sanders et al, 2022). In this work, we evaluate the impact of the NIP implementation model on fidelity to the THRIVE principles of care; a healthcare service unit that embodies the THRIVE principles of care would exhibit high fidelity to THRIVE at macro, meso, and micro levels.…”

Exploring the awareness, attitudes, and actions (AAA) of UK adults at high risk of severe illness from COVID-19

“…The pen profile approach presents findings from content analysis via a diagram of composite key emerging themes [ 11 ]. In summary, deductive content analysis was initially adopted to categorise survey data into four a priori pen profiles including i) awareness, ii) attitudes and concerns, iii) actions, and iv) changes.…”

Food insecurity in people living with obesity: Improving sustainable and healthier food choices in the retail food environment—the FIO Food project

“…WP3 will analyse the focus group data using content analysis, by systematically reviewing and interpreting the discussions, and then presenting them using a pen profile technique. Pen-profiling allows data from content analysis to be organised schematically via a diagram of composite emergent major and minor themes (Sanders et al, 2022). Emergent themes will be organised to illustrate the perspectives held by participants and provide transferrable information to continually develop strategies for the effective delivery of a co-designed, combined retail and weight management intervention conducted in the 'real world'.…”