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      Translating a walking intervention for health professional delivery within primary care: A mixed‐methods treatment fidelity assessment

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          Abstract

          Objectives

          Existing fidelity studies of physical activity interventions are limited in methodological quality and rigour, particularly those delivered by health care providers in clinical settings. The present study aimed to enhance and assess the fidelity of a walking intervention delivered by health care providers within general practice in line with the NIH Behavior Change Consortium treatment fidelity framework.

          Design

          Two practice nurses and six health care assistants delivered a theory‐based walking intervention to 63 patients in their own practices. A cross‐sectional mixed‐methods study assessed fidelity related to treatment delivery and treatment receipt, from the perspectives of health care providers and patients.

          Methods

          All providers received training and demonstrated delivery competence prior to the trial. Delivery of intervention content was coded from audio‐recordings using a standardized checklist. Qualitative interviews with 12 patients were conducted to assess patient perspectives of treatment receipt and analysed using framework analysis.

          Results

          Overall, 78% of intervention components were delivered as per the protocol (range 36–91%), with greater fidelity for components requiring active engagement from patients (e.g., completion of worksheets). The qualitative data highlighted differences in patients’ comprehension of specific intervention components. Understanding of, and engagement with, motivational components aimed at improving self‐efficacy was poorer than for volitional planning components.

          Conclusions

          High levels of fidelity of delivery were demonstrated. However, patient‐, provider‐, and component‐level factors impacted on treatment delivery and receipt. We recommend that methods for the enhancement and assessment of treatment fidelity are consistently implemented to enhance the rigour of physical activity intervention research.

          Statement of contribution

          What is already known on this subject?

          • Physical activity interventions delivered within primary care by health professionals have so far demonstrated limited impact on behaviour change initiation and maintenance.

          • Treatment fidelity enhancement and assessment strategies can support the successful translation of behaviour change interventions into real‐life settings.

          • Few studies have examined treatment fidelity within the context of physical activity interventions, particularly within clinical settings, and existing fidelity studies are limited by methodological quality and rigour.

          What does this study add?

          • High levels of fidelity were found for a physical activity intervention delivered in primary care.

          • Patient‐, provider‐, and component‐level factors may impact on treatment delivery and receipt.

          • The implementation of best practice fidelity recommendations can support near‐optimal fidelity.

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          Most cited references38

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          The theory of planned behavior

          Icek Ajzen (1991)
          Organizational Behavior and Human Decision Processes, 50(2), 179-211
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            Interrater reliability: the kappa statistic

            The kappa statistic is frequently used to test interrater reliability. The importance of rater reliability lies in the fact that it represents the extent to which the data collected in the study are correct representations of the variables measured. Measurement of the extent to which data collectors (raters) assign the same score to the same variable is called interrater reliability. While there have been a variety of methods to measure interrater reliability, traditionally it was measured as percent agreement, calculated as the number of agreement scores divided by the total number of scores. In 1960, Jacob Cohen critiqued use of percent agreement due to its inability to account for chance agreement. He introduced the Cohen’s kappa, developed to account for the possibility that raters actually guess on at least some variables due to uncertainty. Like most correlation statistics, the kappa can range from −1 to +1. While the kappa is one of the most commonly used statistics to test interrater reliability, it has limitations. Judgments about what level of kappa should be acceptable for health research are questioned. Cohen’s suggested interpretation may be too lenient for health related studies because it implies that a score as low as 0.41 might be acceptable. Kappa and percent agreement are compared, and levels for both kappa and percent agreement that should be demanded in healthcare studies are suggested.
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              The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

              CONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity. The objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions. In a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed. This resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above. "BCT taxonomy v1," an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.
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                Author and article information

                Contributors
                stefanie.williams@coventry.ac.uk , https://twitter.com/stef_wills
                Journal
                Br J Health Psychol
                Br J Health Psychol
                10.1111/(ISSN)2044-8287
                BJHP
                British Journal of Health Psychology
                John Wiley and Sons Inc. (Hoboken )
                1359-107X
                2044-8287
                19 November 2019
                February 2020
                : 25
                : 1 ( doiID: 10.1111/bjhp.v25.1 )
                : 17-38
                Affiliations
                [ 1 ] Centre for Intelligent Healthcare Coventry University Coventry UK
                [ 2 ] Health Behaviour Change Research Group School of Psychology NUI Galway Galway Ireland
                [ 3 ] Public Health Warwickshire Warwickshire County Council Warwick UK
                [ 4 ] Warwick Medical School University of Warwick Coventry UK
                [ 5 ] Department of Clinical, Educational and Health Psychology University College London London UK
                [ 6 ] Manchester Centre for Health Psychology School of Health Sciences University of Manchester UK
                Author notes
                [*] [* ]Correspondence should be addressed to Stefanie L. Williams, Centre for Intelligent Healthcare, Coventry University, Priory Street, Coventry CV1 5FB, UK (email: stefanie.williams@ 123456coventry.ac.uk ).
                Author information
                https://orcid.org/0000-0001-9473-6446
                Article
                BJHP12392
                10.1111/bjhp.12392
                7003875
                31746091
                b2b4687d-a7d1-4c87-9607-009bd82eeb70
                © 2019 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 09 April 2019
                : 24 July 2019
                Page count
                Figures: 0, Tables: 4, Pages: 22, Words: 10666
                Funding
                Funded by: Medical Research Council , open-funder-registry 10.13039/501100000265;
                Award ID: G0701821
                Funded by: NHS Warwickshire
                Funded by: Warwick and Coventry Primary Care Research
                Funded by: Coventry University Ethics Committee and the Warwickshire Local Research Ethics Committee
                Award ID: 09/H1211/56
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                February 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.5 mode:remove_FC converted:06.02.2020

                general practice,implementation,intervention,intervention fidelity,physical activity,primary care,treatment fidelity,walking

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