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Treatment Fidelity in Behavior Change Research

A Case Example

Resnick, Barbara; Inguito, Pia; Orwig, Denise; Yahiro, Janet Yu; Hawkes, William; Werner, Michele; Zimmerman, Sheryl; Magaziner, Jay

METHODS
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Background Treatment fidelity refers to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. Assuring optimal treatment fidelity also may decrease the costs of a study and help the research team explain findings.

Approach The Behavioral Change Consortium developed a comprehensive model of treatment fidelity that incorporates 5 areas: (a) study design, (b) training providers, (c) delivery of treatment, (d) receipt of treatment, and (e) enactment of treatment skills. The definitions of these areas and a case example (Testing the Effectiveness of the Exercise Plus Program) are provided.

Results There was evidence of treatment fidelity related to delivery based on careful monitoring of the study implementation. A comprehensive plan for training of the interventionists was provided, although evidence of treatment fidelity to training was not quantified. There were evidence based on observations of treatment sessions of delivery and receipt of the intervention and evidence of enactments based on evaluation of exercise calendars.

Discussion The development and implementation of a treatment fidelity plan requires a careful conceptualization of what is relevant to treatment fidelity in any given study. Monitoring of treatment fidelity ideally requires direct or indirect observations of sessions, which can be built into the study design so that costs are minimal in terms of time and resources. Monitoring treatment fidelity allows research teams to truly test interventions and to develop and implement interventions that ultimately improve the overall health and well-being of individuals.

Barbara Resnick, PhD, CRNP, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Maryland, Baltimore.

Pia Inguito, MSN, RN, is doctoral student, University of Maryland School of Nursing, Baltimore.

Denise Orwig, PhD, is Assistant Professor, Division of Epidemiology, School of Medicine, University of Maryland, Baltimore.

Janet Yu Yahiro, PhD, is Director of Research, Union Memorial Hospital Baltimore, Maryland; and Adjunct Research Associate, Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore.

William Hawkes, PhD, Assistant Professor, Division of Epidemiology, School of Medicine, University of Maryland, Baltimore.

Michele Werner, MS, is Project Coordinator, Division of Epidemiology, School of Medicine, University of Maryland, Baltimore.

Sheryl Zimmerman, MSW, PhD, is Associate Professor, Chapel Hill School of Social Work, University of North Carolina.

Jay Magaziner, MSHyg, PhD, is Professor, Division of Epidemiology, School of Medicine, University of Maryland, Baltimore.

Corresponding author: Barbara Resnick, PhD, CRNP, FAAN, FAANP, School of Nursing, University of Maryland, 655 West Lombard St, Baltimore, MD 21045 (e-mail: barbresnick@aol.com or bresnick@umaryland.edu).

Editor's Note: Materials documenting the review process for this article are posted at http://nursing-research-editor.com.

Accepted for publication November 4, 2004.

© 2005 Lippincott Williams & Wilkins, Inc.