Learning Objective: Identification of a tool available to enhance fidelity in health promotion and preventive interventions with individuals with intellectual disabilities living in group homes and their residential staff.
Purpose: The purpose of this project is to adapt Breitenstein’s Fidelity Checklist and coding manual for use in evaluation of implementation fidelity of the Steps to Effective Problem-Solving program (STEPS), an NIH funded clinical trial to test the efficacy of a preventive training individuals with intellectual disabilities living in group homes and their residential staff in the STEPS program (Breitenstein, 2008a; Breitenstein, 2008b). Hypothesized results are improved social problem-solving skills and reduced problem behaviors of the residents with intellectual disabilities in comparison to an attention-control nutrition program, Food for Life.
Significance: One outcome of clinical trials is moving interventions into wide-scale dissemination outside the research setting. To do this, it is important to evaluate implementation fidelity in the clinical trials and to use implementation fidelity checks once interventions are in wide dissemination (Bellg et al., 2004; Leeuw, Goossens, Vet, & Vlaeyen, 2009). Implementation fidelity has two dimensions, adherence and competence (Breitenstein, et al., 2010). Adherence refers to adherence to the intervention protocol. Competence refers to the completion of process and facilitation skills in an intervention. Previous research on fidelity has addressed evaluating intervention fidelity in group-based interventions versus individual-based interventions, measuring fidelity over time and in multi-site programs (Baer, 2007; Bellg et al., 2004; Dunkley, et al., 2017). Evaluation of implementation fidelity in interventions among people with intellectual disabilities must address the particular issues of the social and communication skills necessary to develop group process in this population. Previous research on addressing implementation fidelity among people with intellectual disabilities used a clinical treatment-based tool rather than a health promotion and preventive intervention-based tool (Jahoda, et al., 2013).
Methods: Breitenstein’s (2008) Fidelity Checklist was used as a model for this research because it addresses the two dimensions of fidelity and has been used for health promotion and preventive interventions. Adherence is measured using a yes/no subscale about activities such as welcoming the group and covering material important to the intervention. Competence is measured using a subscale from one to three; “one” relates to a skill being demonstrated less than 25% of the time; “two” to a skill being demonstrated between 25% to 75% of the time; and “three” to a skill being demonstrated more than 75% of the time. Skills include elements such as actively engaging and listening, positive attitude and nonjudgmental manner; appropriately reinforcing participants’ ideas and opinions, and facilitating the sharing of ideas. Two coders will check two audiotaped sessions from each of 7-10 homes that have participated in the STEPS and Food for Life interventions. After coding they will meet to determine actions and responses in the interventions representative of each score and the congruence/non-congruence with coding instructions in the original coding manual.
Results: Results will be reported in a table with columns for Breitenstein’s original coding scheme and the coding scheme decided on as relevant for this intervention. Information will be used to complete modification of the Fidelity Checklists for the two interventions and to edit the coding manual so that it is suitable for evaluating implementation fidelity for the STEPS research.
Implications: This work will improve our knowledge of evaluating implementation fidelity among individuals with intellectual disabilities and in developing tools to evaluate implementation fidelity during wide-scale dissemination.
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