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Establishing Treatment Fidelity in a Web-Based Behavioral Intervention Study

Eaton, Linda H.; Doorenbos, Ardith Z.; Schmitz, KrisAnn L.; Carpenter, Kelly M.; McGregor, Bonnie A.

doi: 10.1097/NNR.0b013e31823386aa

Background: Treatment fidelity pertains to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. Approaches to establishing treatment fidelity in Web-based interventions differ from those used in interventions that are delivered in person.

Objective: The aim of this study was to describe a methodology for ensuring treatment fidelity in a Web-based cognitive behavioral stress management intervention.

Methods: The intervention Coping With Cancer Workbook, adapted for Web-based delivery from an in-person intervention, was tested in a randomized controlled trial with 123 breast cancer survivors. Strategies for ensuring treatment fidelity were implemented and assessed.

Results: The National Institutes of Health Behavior Change Consortium Treatment Fidelity Guidelines were relevant to establishing treatment fidelity for the Web-based intervention.

Discussion: Web-based delivery of behavioral interventions is both a strength and a threat to treatment fidelity. Investigators must be cognizant of the elements of treatment fidelity and implement strategies to monitor and improve the reliability and validity of Web-based interventions.

Supplemental Digital Content is available in the text

Linda H. Eaton, MN, RN, AOCN, is Research Nurse; and Ardith Z. Doorenbos, PhD, RN, FAAN, is Associate Professor, Biobehavioral Nursing and Health Systems, University of Washington, Seattle.

KrisAnn L. Schmitz, MSW, is Research Associate; and Kelly M. Carpenter, PhD, is Senior Research Scientist, Talaria, Inc., Seattle, Washington.

Bonnie A. McGregor, PhD, is Associate Member, Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, Washington.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication August 16, 2011.

This research was supported by funding from National Cancer Institute (2 R44 CA106154-02A1) and National Institute of Nursing Research (R21NR010725-01).

The authors have no conflicts of interest to disclose.

Corresponding author: Linda H. Eaton, MN, RN, AOCN, Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA 98195-7266 (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.