Implementation Fidelity: Frameworks, Application, and Reporting in Intervention Research

Calls for standardization of reporting in research have led to the development of a number of frameworks, including: 1) the Consolidated Standards of Reporting Trial (CONSORT) statement, which provides key items that need to be reported regarding randomized study design, participation, analysis and interpretation; 2) the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT), which provides guidance specifically for the content of trial protocols, 3) the Template for Intervention Description and Replication (TIDieR) checklist and guide, which expands on the CONSORT statement and SPIRIT protocols with the goal of improving completeness in reporting, and 4) the Workgroup for Intervention Development and Evaluation Research (WIDER) recommendations, which emerged from the 2007 annual conference of the European Health Psychology Society and supplements the CONSORT by calling for additional elements to be reported from behavior change intervention research including adherence or fidelity to delivery protocols. In addition, Gearing and colleagues (2011) contributed to our understanding of how to conceptualize intervention fidelity through a systematic review that identified four core components: 1) intervention design and protocols; 2) intervention training; 3) monitoring of intervention delivery; and 4) monitoring of intervention receipt.

The purpose of this roundtable is to: 1) discuss intervention fidelity and how it is defined by these frameworks, 2) explore how fidelity measures were used to guide and identify challenges in four summative research projects, 3) engage in dialogue with participants on how they have addressed fidelity concerns in their research, and 4) explore models for fidelity reporting.

The research projects that will serve as case examples include: 1) Tuning in to Teens (TINT) in New Jersey, where fidelity monitoring identified fidelity-consistent adaptations to the intervention and their utilization and study specific implementation supports that would not be standard under real-world conditions and may affect replication results; 2) The Family Success Network (FSN) will discuss the collaborative process of developing a matrix of fidelity measures that take into consideration a multitude of interventions, with varying levels of evidence; 3) Virginia Children’s Services Practice Profile Initiative, where fidelity measurement quickly determined that the project should reconfigure as a formative assessment and data were utilized to create implementation support tools; and 4) The Neurosequential Model of Therapeutics (NMT), where fidelity was developed while implementing the model. We will discuss how fidelity to the NMT recommendations were measured, and the challenges and strengths of using fidelity to understand program outputs.

Panelists will discuss their own experiences and those of state agency staff engaged in the research that has been shared with them. This is intended to increase awareness of the frameworks for standardization of study reporting and skills for identifying utilization of fidelity monitoring during intervention implementation and reporting. Appropriate utilization of the frameworks is necessary to provide greater understanding of the contexts under which interventions have demonstrated efficacy and ascertain whether they are replicable under real world conditions by public and private agencies.