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Measuring fidelity to enhance delivery of obesity treatment and its future translation into practice: Application in the ASPIRE-VA small changes weight loss trial.
Damschroder LJ, Goodrich DE, Gillon LR, Richardson CR, Lutes LL. Measuring fidelity to enhance delivery of obesity treatment and its future translation into practice: Application in the ASPIRE-VA small changes weight loss trial. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2012 Apr 11; New Orleans, LA.
Effective treatments are urgently needed to address the obesity epidemic. However, treatments shown to be effective in trials often fall short when translated into practice; often because the high level of interventionist expertise and controlled environment cannot be replicated reliably. Lack of fidelity reporting has also limited progress. The ASPIRE-VA multi-site RCT is testing effectiveness of a theoretically-driven small changes treatment approach to weight loss that focuses on patient-driven choices in monitoring and setting small but manageable dietary and physical activity goals relative to baseline behaviors, among Veterans. A comprehensive fidelity monitoring system, linked to coach supervision, was prospectively built into the trial. A sample of group and individual sessions were recorded and scored for the degree to which interventionists delivered treatment as intended along five theoretically-driven dimensions: self-monitoring and goal attainment; core psycho-educational content; action planning; interventionist characteristics; and process quality. Based on preliminary data, 118 of 2169 delivered sessions were recorded and scored on a 0 (absent) - 2 (100% present) scale. Interventionists were consistently effective in helping patients self-monitor and in checking goal attainment (scoring an average of a perfect 2 at the beginning and end of a 16-month measurement period). They showed dramatic improvement in delivering core psycho-educational content over the same period (improving .68 to 1.78) but continue to struggle with action planning (1.2 to 1.54). Using undergraduate coaches may be an affordable way to promote translation of weight management interventions into practice. Furthermore, fidelity measures provide detailed information needed to judge viability of translating a program into a particular setting.