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Implementation Science
Published in: Implementation Science 1/2013

Open Access 01-12-2013 | Research

Assessing fidelity of delivery of smoking cessation behavioural support in practice

Authors: Fabiana Lorencatto, Robert West, Charlotte Christopherson, Susan Michie

Published in: Implementation Science | Issue 1/2013

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Abstract

Background

Effectiveness of evidence-based behaviour change interventions is likely to be undermined by failure to deliver interventions as planned. Behavioural support for smoking cessation can be a highly cost-effective, life-saving intervention. However, in practice, outcomes are highly variable. Part of this may be due to variability in fidelity of intervention implementation. To date, there have been no published studies on this. The present study aimed to: evaluate a method for assessing fidelity of behavioural support; assess fidelity of delivery in two English Stop-Smoking Services; and compare the extent of fidelity according to session types, duration, individual practitioners, and component behaviour change techniques (BCTs).

Methods

Treatment manuals and transcripts of 34 audio-recorded behavioural support sessions were obtained from two Stop-Smoking Services and coded into component BCTs using a taxonomy of 43 BCTs. Inter-rater reliability was assessed using percentage agreement. Fidelity was assessed by examining the proportion of BCTs specified in the manuals that were delivered in individual sessions. This was assessed by session type (i.e., pre-quit, quit, post-quit), duration, individual practitioner, and BCT.

Results

Inter-coder reliability was high (87.1%). On average, 66% of manual-specified BCTs were delivered per session (SD 15.3, range: 35% to 90%). In Service 1, average fidelity was highest for post-quit sessions (69%) and lowest for pre-quit (58%). In Service 2, fidelity was highest for quit-day (81%) and lowest for post-quit sessions (56%). Session duration was not significantly correlated with fidelity. Individual practitioner fidelity ranged from 55% to 78%. Individual manual-specified BCTs were delivered on average 63% of the time (SD 28.5, range: 0 to 100%).

Conclusions

The extent to which smoking cessation behavioural support is delivered as specified in treatment manuals can be reliably assessed using transcripts of audiotaped sessions. This allows the investigation of the implementation of evidence-based practice in relation to smoking cessation, a first step in designing interventions to improve it. There are grounds for believing that fidelity in the English Stop-Smoking Services may be low and that routine monitoring is warranted.
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Literature
1.
Lancaster T, Stead LF: Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev. 2005, CD001292-
2.
Stead LF, Lancaster T: Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst Rev. 2005, CD001007-
3.
Stead L, Perera R, Lancaster T: Telephone counseling for smoking cessation. Cochrane Database Syst Rev. 2006, 2005: CD002850
4.
Michie S, Churchill S, West R: Identifying evidence-based competences required to deliver behavioural support for smoking cessation. Ann Behav Med. 2011, 41 (1): 59-70. 10.1007/s12160-010-9235-z.CrossRefPubMed
5.
West R, Stapleton J: Clinical and public health significance of treatments to aid smoking cessation. Eur Respir Rev. 2008, 17 (110): 199-204. 10.1183/09059180.00011005.CrossRef
6.
Lorencatto F, West R, Michie S: Identifying evidence-based behaviour change techniques for smoking cessation in pregnancy. Nicotine & Tobacco Research. 2012, 14 (9): 1019-1026. 10.1093/ntr/ntr324.CrossRef
7.
Raw M, Regan S, Rigotti NA, McNeill A: A survey of tobacco dependence treatment services in 36 countries. Addiction. 2009, 104 (2): 279-87. 10.1111/j.1360-0443.2008.02443.x.CrossRefPubMedPubMedCentral
8.
Ferguson J, Bauld L, Chesterman J, Judge K: The English smoking treatment services: one-year outcomes. Addiction. 2005, 100 (2): 59-69.CrossRefPubMed
9.
Eccles M, Armstrong D, Baker R, Cleary K, Davies H, Davies S: An implementation research agenda. Implement Sci. 2009, 4 (18): 1-7.
10.
Wilson G: Manual-based treatments: the clinical application of research findings. Behav Res Ther. 1996, 34: 295-314. 10.1016/0005-7967(95)00084-4.CrossRefPubMed
11.
Wallace L, Ranson M: Treatment manuals: Use in treatment of bulimia nervosa. Behav Res Ther. 2011, 49: 815-820. 10.1016/j.brat.2011.09.002.CrossRefPubMed
12.
Cukrowicz K, Timmons K, Sawyer K, Caron K, Gummelt H, Joiner T: Improved treatment outcome associated witht he shift to empirically supported treatments in an outpatient clinic is maintained over a ten-year period. Professional Psychology: Research and Practice. 2011, 42: 145-152.CrossRef
13.
14.
West R, McNeill A, Raw M: National smoking cessation guidelines for health professionals: an update. Thorax. 2000, 55 (12): 987-999. 10.1136/thorax.55.12.987.CrossRefPubMedPubMedCentral
15.
Brose LS, McEwen A, West R: Does it matter who you see to help you stop smoking? short-term quit rates across specialist stop smoking practitioners in England. Addiction. 2012, 107 (11): 2029-2036. 10.1111/j.1360-0443.2012.03935.x. online first 9.5.2012. in pressCrossRefPubMed
16.
Borrelli B: The assessment, monitoring and enhancement of fidelity in public health clinical trials. Journal of Public Health Dentistry. 2011, 71 (s1): 52-63.CrossRef
17.
Bellg A, Borrelli B, Resnick B, Hecht J, Minicucci DS, Ory M, Ogedegbe G, Orwig D, Ernst D, Czajkowski S: Enhancing treatment fidelity in health behaviour change studies: best practices and recommendations from the NIH behaviour change consortium. Health Psychology. 2004, 22 (5): 443-451.CrossRef
18.
Dusenbury L, Brannigan R, Falco M, Hansen WB: A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Education Research: Theory and Practice. 2003, 18 (2): 237-256.CrossRef
19.
Boutron I, Moher D, Altman D, Scultz K, Ravaud P: Extending the CONSORT statement to randomized trials of Non-pharmacologic treatment: explanation and elaboration. Annals of Internal Medicine. 2008, 148: 295-309.CrossRefPubMed
20.
Moncher F, Prinz R: Treatment fidelity in outcome studies. Clinical psychology review. 1991, 11: 247-266. 10.1016/0272-7358(91)90103-2.CrossRef
21.
Dane A, Schnieder B: Program integrity in primary and early secondary prevention: are implementation effects out of control?. Clinical Psychology Review. 1998, 18: 22-45.CrossRef
22.
Hardeman W, Michie S, Fanshawe T, Prevost T, Mcloughlin K, Kinmonth AL: Fidelity of a physical activity intervention: predictors and consequences. Psychology and Health. 2008, 23 (1): 11-24. 10.1080/08870440701615948.CrossRefPubMed
23.
Tober G, Clyne W, Finnegan O, Farrin A, Russell I: Validation of a scale for rating the delivery of psycho-social treatments for alcohol dependence and misuse: the UKATT process rating scale (PRS). Alcohol and Alcoholism. 2008, 43 (6): 675-682. 10.1093/alcalc/agn064.CrossRefPubMed
24.
Michie S, Walia A, Hyder N, West R: Development of a taxonomy of behaviour change techniques used in individual behavioural support for smoking cessation. Addictive behaviours. 2010, 36 (4): 315-319.CrossRef
25.
West R, Walia A, Hyder N, Michie S: Behaviour change techniques used by the English stop smoking services and their associations with short-term quit outcomes. Nicotine & Tobacco Research. 2010, 12 (7): 742-747. 10.1093/ntr/ntq074.CrossRef
26.
Michie S, Churchill S, West R: Identifying evidence-based competences required to deliver behavioural support for smoking cessation. Annals of Behavioural Medicine. 2011, 41: 49-70.CrossRef
27.
Lorencatto F, West R, Seymour N, Kaplunov E, Michie S: Developing a method for specifying components of behaviour change interventions delivered in practice: the example of smoking cessation. Journal of Consulting and Clinical Psychology. 2013, In Press
28.
29.
30.
Steinijans V, Diletti E, Bomches B, Greis C, Solleder P: Interobserver agreement: Cohen’s kappa coefficient does not necessarily reflect the percentage of patients with congruent classifications. Int Journal Clinical Pharmacological Therapy. 1997, 35 (3): 93-5.
31.
Noell G, Gresham F, Gansle K: Does treatment integrity matter? A preliminary investigation of instructional implementation and mathematical performance. Journal of Behavioural Education. 2002, 22: 51-67.CrossRef
32.
Holcombe A, Wolery M, Synder E: Effects of two levels of procedural fidelity with constant time delay on children’s leraning. Journal of Behavioural Education. 1994, 4: 49-73. 10.1007/BF01560509.CrossRef
33.
McDermott M, Thomson H, West R, Kenyon J, McEwen A: Translating evidence-based guidelines into practice: a survey of practices of commissioners and managers of the English Stop Smoking Services. BMC Health Services Research. 2012, 12 (121): 1-8.
34.
Borrelli B, Hecht J, Papandonatos G, Emmons J, Tatewosian L, Abrams D: Smoking cessation counseling in the home. Attitdues, beliefs, and behaviours of home healthcare nurses. American Journal Preventative Medicine. 2001, 21 (4): 272-7. 10.1016/S0749-3797(01)00369-5.CrossRef
35.
Gardner B, Whittington C, McAteer J, Eccles M, Michie S: Using theory to synthesise evidence from behaviour change interventions: the example of audit and feedback. Social Science Medicine. 2010, 70 (10): 1618-25. 10.1016/j.socscimed.2010.01.039.CrossRefPubMed
36.
Michie S, Ashford S, Sniehotta FF, Dombrowski SU, Bishop A, French DP: A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours – the CALO-RE taxonomy. Psychology & Health. 2011, 26 (11): 1479-1498. 10.1080/08870446.2010.540664.CrossRef
37.
Michie S, Whittington C, Hamoudi Z, Zarani F, Tober G, West R: Behaviour change techniques to reduce excessive alcohol use and their associations with outcome. Addiction. 2012, 107 (8): 1431-1440. 10.1111/j.1360-0443.2012.03845.x.CrossRefPubMed
38.
Michie S, Abraham C, Eccles M, Francis J, Hardeman W, Johnston M: Strengthening evaluation and implementation by specifying components of behaviour change interventions: a study protocol. Implementation Science. 2011, 6 (10):
39.
Leventhal H, Friedman M: Does establishing fidelity of treatment help in understanding treatment efficacy?. Health Psychology. 2004, 23 (5): 452-456.CrossRefPubMed
40.
Kendall P, Gosch E, Furr J, Sood E: Flexibility within fidelity. Journal A, Acad Child Adolescent Psychiatry. 2008, 47 (9): 987-93.CrossRef
41.
Durlak J, DuPre E: Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology. 2008, 41 (3): 327-50. 10.1007/s10464-008-9165-0.CrossRefPubMed
Metadata
Title
Assessing fidelity of delivery of smoking cessation behavioural support in practice
Authors
Fabiana Lorencatto
Robert West
Charlotte Christopherson
Susan Michie
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2013
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-8-40

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