Teacher Fidelity in the COPE Healthy Lifestyles TEEN Randomized Controlled Trial: Lessons Learned and Implications for Future Research

Purpose: To report on the intervention fidelity by teachers in a large scale randomized controlled trial that tested the efficacy of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) Program with 779 adolescents in 11 high schools in a large southwest metropolitan area.

Methods:  Fidelity to the COPE intervention delivered by the health teachers was assessed through direct observation by research team members. 

Results: Thirty classroom teachers delivered the 15-session COPE cognitive-behavioral intervention to teens as part of their health course. The majority of teens were Hispanic (67.52%).  Observers rated approximately 25% of the teachers’ intervention sessions using an observation instrument of intervention fidelity that was developed for use in the study.  There were a total of 107 observations completed during the study with 30 teachers (mean per teacher=3.6, SD=0.8). There was excellent inter-rater reliability of 90% for the fidelity observations between raters.  Observed incidents of decreased fidelity to the intervention occurred at least once, in approximately half of the classrooms.

Conclusions: Findings from this study demonstrate the importance of monitoring fidelity to intervention implementation.  It is common for intervention components to be delivered in a manner not consistent with the research protocol, which may decrease intervention effects. Early identification and resolution of deviations from the research protocol can improve overall fidelity.  It is imperative for future studies to monitor teacher implementation and provide added supports to increase intervention fidelity.