Verifying intervention fidelity procedures for a palliative home care intervention with pilot study results

Abstract

Fidelity (consistency of intervention implementation) is essential to rigorous research. Intervention fidelity maintains study internal validity, intervention reproducibility, and transparency in the research conduct. The purpose of this manuscript is to describe intervention fidelity strategies/procedures developed for a pilot study testing a new palliative care nursing intervention (FamPALcare) for families managing advanced lung disease. The procedures described herein are based on the fidelity best practices recommendations from the NIH Consortium. An evidence‐based checklist guided observational ratings of the fidelity procedures used and the intervention content implemented in each intervention session. Descriptive data on how participants understood (received), enacted, or used the intervention information were summarized. The fidelity checklist observational scores found ≥93% of the planned intervention content was implemented, and the fidelity strategies were adhered to consistently during each intervention session. The small variation (7%) in implementation was expected and related to participants' varying experiences, input, and/or questions. The helpfulness scale items include participants' ability to use home care resources, to anticipate and manage end‐of‐life symptoms, and to use Advance Directive forms. The high ratings (M = 4.4) on the 1–5 (very helpful) Likert Helpfulness Scale verified participants utilized the information from the intervention. Furthermore, there was an improvement in patients' breathlessness scores and completion of Advance Directive forms at 3 months after baseline. It is essential to plan intervention fidelity strategies to use throughout a study and to report fidelity results.

Around the EQUATOR with clinician‐scientists transdisciplinary aging research (Clin‐STAR) principles: Implementation science challenges and opportunities

“…One study of a palliative care nurse intervention used a 5-point Likert "helpfulness" scale, to assess participants' ability to use the intervention tools. 50 Fidelity assessments can greatly inform future trials, and often yield interesting new barriers or motivations. A study of a Coach2Move intervention led by physical therapists for older adults assessed fidelity through a scale and follow-up qualitative interviews.…”

“…Tele‐observation (video conference or recording sessions for asynchronous review), direct observation, or asking participants to rate the elements of an intervention by how compliant they were to each one may be ways to assess intervention fidelity. One study of a palliative care nurse intervention used a 5‐point Likert “helpfulness” scale, to assess participants' ability to use the intervention tools 50 …”

Developing, implementing, and evaluating the visiting Neighbors’ program in rural Appalachia: A quality improvement protocol

“…Comments and requests were used to assist in improving our future programs. Thus, the project director monitored the fidelity across the study timeline to ensure the reliable and valid implementation of the Visiting Neighbors program [ 46 ]. At each subsequent visit, the visitors reviewed the previous visit’s content and 3M’s activities and provided reinforcement or demonstration, if needed.…”