Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study
Background: Evaluation of complex interventions should include a process evaluation to give evaluators, researchers, and policy makers greater confidence in the outcomes reported from RCTs. Implementation fidelity can be part of a process evaluation and refers to the degree to which an intervention...
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2019
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Online Access: | https://hdl.handle.net/10642/6867 https://doi.org/10.1186/s12874-019-0694-z |
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English |
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Process evaluations Implementation fidelities Strokes Psychosocial interventions Mixed methods |
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Process evaluations Implementation fidelities Strokes Psychosocial interventions Mixed methods Bragstad, Line Kildal Bronken, Berit Arnesveen Sveen, Unni Hjelle, Ellen Gabrielsen Kitzmüller, Gabriele Martinsen, Randi Kvigne, Kari Johanne Mangset, Margrete Kirkevold, Marit Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study |
topic_facet |
Process evaluations Implementation fidelities Strokes Psychosocial interventions Mixed methods |
description |
Background: Evaluation of complex interventions should include a process evaluation to give evaluators, researchers, and policy makers greater confidence in the outcomes reported from RCTs. Implementation fidelity can be part of a process evaluation and refers to the degree to which an intervention is delivered according to protocol. The aim of this implementation fidelity study was to evaluate to what extent a dialogue-based psychosocial intervention was delivered according to protocol. A modified conceptual framework for implementation fidelity was used to guide the analysis. Methods: This study has an explanatory, sequential two-phase mixed methods design. Quantitative process data were collected longitudinally along with data collection in the RCT. Qualitative process data were collected after the last data collection point of the RCT. Descriptive statistical analyses were conducted to describe the sample, the intervention trajectories, and the adherence measures. A scoring system to clarify quantitative measurement of the levels of implementation was constructed. The qualitative data sources were analyzed separately with a theory-driven content analysis using categories of adherence and potential moderating factors identified in the conceptual framework of implementation fidelity. The quantitative adherence results were extended with the results from the qualitative analysis to assess which potential moderators may have influenced implementation fidelity and in what way. Results: The results show that the core components of the intervention were delivered although the intervention trajectories were individualized. Based on the composite score of adherence, results show that 80.1% of the interventions in the RCT were implemented with high fidelity. Although it is challenging to assess the importance of each of the moderating factors in relation to the other factors and to their influence on the adherence measures, participant responsiveness, comprehensiveness of policy description, context, and recruitment appeared to be the most prominent moderating factors of implementation fidelity in this study. Conclusions: This evaluation of implementation fidelity and the discussion of what constitutes high fidelity implementation of this intervention are crucial in understanding the factors influencing the trial outcome. The study also highlights important methodological considerations for researchers planning process evaluations and studies of implementation fidelity. The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7-PEOPLE-2013-COFUND) under grant agreement no 609020 - Scientia Fellows. The research has also been supported by a grant from the South-Eastern Norway Regional Health Authority (Project no 2013086) and a grant from the Extra Foundation (2015/FO13753). The University of Oslo, Oslo University Hospital, the Inland Norway University of Applied Sciences, and UiT, the Arctic University of Norway, Narvik have provided research time, administrative and organizational support and additional funding for the study. publishedVersion |
format |
Article in Journal/Newspaper |
author |
Bragstad, Line Kildal Bronken, Berit Arnesveen Sveen, Unni Hjelle, Ellen Gabrielsen Kitzmüller, Gabriele Martinsen, Randi Kvigne, Kari Johanne Mangset, Margrete Kirkevold, Marit |
author_facet |
Bragstad, Line Kildal Bronken, Berit Arnesveen Sveen, Unni Hjelle, Ellen Gabrielsen Kitzmüller, Gabriele Martinsen, Randi Kvigne, Kari Johanne Mangset, Margrete Kirkevold, Marit |
author_sort |
Bragstad, Line Kildal |
title |
Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study |
title_short |
Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study |
title_full |
Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study |
title_fullStr |
Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study |
title_full_unstemmed |
Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study |
title_sort |
implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study |
publisher |
BMC |
publishDate |
2019 |
url |
https://hdl.handle.net/10642/6867 https://doi.org/10.1186/s12874-019-0694-z |
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ENVELOPE(17.427,17.427,68.438,68.438) |
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Arctic Narvik Norway |
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Arctic Narvik Norway |
genre |
Narvik Narvik Arctic University of Norway UiT The Arctic University of Norway |
genre_facet |
Narvik Narvik Arctic University of Norway UiT The Arctic University of Norway |
op_source |
BMC Medical Research Methodology |
op_relation |
BMC Medical Research Methodology;19, Article number: 59 (2019) Bragstad LK, Bronken B, Sveen US, Hjelle EG, Kitzmüller GE, Martinsen RE, Kvigne K, Mangset M, Kirkevold M. Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study. BMC Medical Research Methodology. 2019;19(59) urn:issn:1471-2288 https://hdl.handle.net/10642/6867 http://dx.doi.org/10.1186/s12874-019-0694-z cristin:1685276 |
op_rights |
© The Author(s). 2019 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. https://creativecommons.org/licenses/by/4.0/ |
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CC0 PDM CC-BY |
op_doi |
https://doi.org/10.1186/s12874-019-0694-z |
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BMC Medical Research Methodology |
container_volume |
19 |
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1 |
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1766071433129099264 |
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fthsosloakersoda:oai:oda.oslomet.no:10642/6867 2023-05-15T17:14:09+02:00 Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study Bragstad, Line Kildal Bronken, Berit Arnesveen Sveen, Unni Hjelle, Ellen Gabrielsen Kitzmüller, Gabriele Martinsen, Randi Kvigne, Kari Johanne Mangset, Margrete Kirkevold, Marit 2019-03-15T22:13:21Z application/pdf https://hdl.handle.net/10642/6867 https://doi.org/10.1186/s12874-019-0694-z en eng BMC BMC Medical Research Methodology;19, Article number: 59 (2019) Bragstad LK, Bronken B, Sveen US, Hjelle EG, Kitzmüller GE, Martinsen RE, Kvigne K, Mangset M, Kirkevold M. Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study. BMC Medical Research Methodology. 2019;19(59) urn:issn:1471-2288 https://hdl.handle.net/10642/6867 http://dx.doi.org/10.1186/s12874-019-0694-z cristin:1685276 © The Author(s). 2019 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. https://creativecommons.org/licenses/by/4.0/ CC0 PDM CC-BY BMC Medical Research Methodology Process evaluations Implementation fidelities Strokes Psychosocial interventions Mixed methods Journal article Peer reviewed 2019 fthsosloakersoda https://doi.org/10.1186/s12874-019-0694-z 2021-10-11T16:54:54Z Background: Evaluation of complex interventions should include a process evaluation to give evaluators, researchers, and policy makers greater confidence in the outcomes reported from RCTs. Implementation fidelity can be part of a process evaluation and refers to the degree to which an intervention is delivered according to protocol. The aim of this implementation fidelity study was to evaluate to what extent a dialogue-based psychosocial intervention was delivered according to protocol. A modified conceptual framework for implementation fidelity was used to guide the analysis. Methods: This study has an explanatory, sequential two-phase mixed methods design. Quantitative process data were collected longitudinally along with data collection in the RCT. Qualitative process data were collected after the last data collection point of the RCT. Descriptive statistical analyses were conducted to describe the sample, the intervention trajectories, and the adherence measures. A scoring system to clarify quantitative measurement of the levels of implementation was constructed. The qualitative data sources were analyzed separately with a theory-driven content analysis using categories of adherence and potential moderating factors identified in the conceptual framework of implementation fidelity. The quantitative adherence results were extended with the results from the qualitative analysis to assess which potential moderators may have influenced implementation fidelity and in what way. Results: The results show that the core components of the intervention were delivered although the intervention trajectories were individualized. Based on the composite score of adherence, results show that 80.1% of the interventions in the RCT were implemented with high fidelity. Although it is challenging to assess the importance of each of the moderating factors in relation to the other factors and to their influence on the adherence measures, participant responsiveness, comprehensiveness of policy description, context, and recruitment appeared to be the most prominent moderating factors of implementation fidelity in this study. Conclusions: This evaluation of implementation fidelity and the discussion of what constitutes high fidelity implementation of this intervention are crucial in understanding the factors influencing the trial outcome. The study also highlights important methodological considerations for researchers planning process evaluations and studies of implementation fidelity. The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7-PEOPLE-2013-COFUND) under grant agreement no 609020 - Scientia Fellows. The research has also been supported by a grant from the South-Eastern Norway Regional Health Authority (Project no 2013086) and a grant from the Extra Foundation (2015/FO13753). The University of Oslo, Oslo University Hospital, the Inland Norway University of Applied Sciences, and UiT, the Arctic University of Norway, Narvik have provided research time, administrative and organizational support and additional funding for the study. publishedVersion Article in Journal/Newspaper Narvik Narvik Arctic University of Norway UiT The Arctic University of Norway OsloMet (Oslo Metropolitan University): ODA (Open Digital Archive) Arctic Narvik ENVELOPE(17.427,17.427,68.438,68.438) Norway BMC Medical Research Methodology 19 1 |