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Monitoring treatment fidelity in a randomized controlled trial of a complex intervention

Authors

  • Valerie Spillane,

    1. Valerie Spillane MA RN RM
      Nurse Researcher
      Department of General Practice, National University of Ireland, Galway, Ireland
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  • Mary C. Byrne,

    1. Mary C. Byrne PhD
      Project Manager
      Department of General Practice, National University of Ireland, Galway, Ireland
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  • Molly Byrne,

    1. Molly Byrne PhD
      Health Psychologist & Lecturer in Psychology
      Department of Psychology, St Anthony’s, National University of Ireland, Galway, Ireland
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  • Claire S. Leathem,

    1. Claire S. Leathem BSc RN
      Principal Nurse Researcher
      Division of Public Health Medicine & Primary Care, Queen’s University Belfast, Belfast, UK
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  • Mary O’Malley,

    1. Mary O’Malley RN HDip
      Nurse Researcher
      Department of Public Health & Primary Care, Trinity College Centre for Health Sciences, Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght, Dublin, Ireland
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  • Margaret E. Cupples

    1. Margaret E. Cupples MD FRCGP
      General Practitioner & Senior Lecturer in General Practice
      Division of Public Health Medicine & Primary Care, Queen’s University Belfast, Belfast, UK
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M.C. Byrne e-mail: mary.byrne@nuigalway.ie

Abstract

Title. Monitoring treatment fidelity in a randomized controlled trial of a complex intervention

Aim.  This paper is a report of a study to describe how treatment fidelity is being enhanced and monitored, using a model from the National Institutes of Health Behavior Change Consortium.

Background.  The objective of treatment fidelity is to minimize errors in interpreting research trial outcomes, and to ascribe those outcomes directly to the intervention at hand. Treatment fidelity procedures are included in trials of complex interventions to account for inferences made from study outcomes. Monitoring treatment fidelity can help improve study design, maximize reliability of results, increase statistical power, determine whether theory-based interventions are responsible for observed changes, and inform the research dissemination process.

Methods.  Treatment fidelity recommendations from the Behavior Change Consortium were applied to the SPHERE study (Secondary Prevention of Heart DiseasE in GeneRal PracticE), a randomized controlled trial of a complex intervention. Procedures to enhance and monitor intervention implementation included standardizing training sessions, observing intervention consultations, structuring patient recall systems, and using written practice and patient care plans. The research nurse plays an important role in monitoring intervention implementation.

Findings.  Several methods of applying treatment fidelity procedures to monitoring interventions are possible. The procedure used may be determined by availability of appropriate personnel, fiscal constraints, or time limits. Complex interventions are not straightforward and necessitate a monitoring process at trial stage.

Conclusion.  The Behavior Change Consortium’s model of treatment fidelity is useful for structuring a system to monitor the implementation of a complex intervention, and helps to increase the reliability and validity of evaluation findings.

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