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Measuring Fidelity to Enhance Delivery of Obesity Treatment and its Future Translation into Practice: Application in the ASPIRE-VA RCT
Damschroder LJ, Goodrich DE, Richardson CR, Ronis DL, Lowery JC, Kirsh S, Dinatale E, Lutes LL. Measuring Fidelity to Enhance Delivery of Obesity Treatment and its Future Translation into Practice: Application in the ASPIRE-VA RCT. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 19; National Harbor, MD.
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-centered choices in monitoring and setting small but manageable dietary and physical activity goals relative to baseline behaviors, among 481 Veterans. Non-clinical lifestyle coaches were trained as part of this trial. We adapted a comprehensive fidelity monitoring framework to the study. This pragmatic framework includes continuous monitoring of fidelity to core treatment elements via coach session checklists, indirect observations and scoring of session delivery, and an ongoing quality assurance feedback loop to correct deviations from core objectives. One component of our framework included audio-recording and scoring a sample of group and individual sessions on the degree to which coaches delivered treatment as intended along five theoretically-driven dimensions: self-monitoring and goal attainment; core psycho-educational content; action planning; coach characteristics; and process quality.
Based on preliminary data, 118 (5%) of 2,169 completed sessions were recorded and items (e.g., the coach prompts level of goal attainment) were scored on a 0 (absent) - 2 (100% present) scale. Coaches 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 0.68 to 1.78) and continue to develop in setting action plans with their patients (1.2 to 1.54). Other fidelity measures will also be presented.
Using non-clinical coaches may be an affordable way to promote translation of weight management interventions into practice. Furthermore, comprehensive fidelity measures provide detailed information needed to judge viability of translating a program into a particular setting.
A comprehensive fidelity framework will provide rich information to guide future implementation of ASPIRE-VA.