Measuring fidelity to behavioural support delivery for smoking cessation and its association with outcomes

Omara Dogar (Lead / Corresponding author), Jan Boehnke, Fabiana Lorencatto, Trevor A. Sheldon, Kamran Siddiqi

    Research output: Contribution to journalArticle

    Abstract

    Background and aims: Behavioural support increases smoking cessation in clinical settings, but effect sizes differ among providers, possibly due to variations in delivery. This study evaluates a measure (“fidelity index”) intended to capture fidelity to delivery of content-based and interactionbased items of a Behavioural Support (BS) for smoking cessation and the association of fidelity with quit rates.

    Methods: A fidelity index for scoring the adherence and quality domains of a specific BS intervention, 5As for quit, was developed by classifying the intervention components using the taxonomy of Behaviour Change Techniques. The index was applied to code 154 BS sessions audiotaped across 18 chest clinics in Pakistan to assess their fidelity and explore reliability of coding. The association between intervention fidelity and successful quit achieved by the same providers in a previous study was explored using regression analysis.

    Results: The index represented two domains: adherence to delivery of content-based activities of 5As (37 items) and quality of interaction-based activities (8 items). The inter-coder reliability was good for content-based (average Krippendorff's α = 0.80) and moderate for interactionbased (average Krippendorff's α = 0.66) items. About 70% (Intra-class Correlation Coefficient: adherence scores = 0.72, quality scores = 0.71) of variation in BS delivery was contributed by providers, which increased to 97% (g-coefficient: adherence scores = 0.973, quality scores = 0.974) after accounting for other sources of variation. Higher quit rates were positively associated with average quality scores (risk ratio: 2.15; 95% CI, 1.43 to 3.24), but negatively associated with average adherence scores (risk ratio: 0.55; 95% CI, 0.40 to 0.77), within services.

    Conclusions: The fidelity index is a reliable measure for quantifying intervention fidelity of delivering smoking cessation behavioural support. Recommended revisions of the fidelity index include incorporation of additional interaction-based items, like the relational techniques used in motivational interviewing.
    Original languageEnglish
    Number of pages25
    JournalAddiction
    Early online date8 Sep 2019
    DOIs
    Publication statusE-pub ahead of print - 8 Sep 2019

    Fingerprint

    Smoking Cessation
    Odds Ratio
    Motivational Interviewing
    Pakistan
    Thorax
    Regression Analysis

    Keywords

    • Behavioural Support
    • Behaviour Change Techniques
    • Smoking cessation
    • Intervention fidelity
    • Fidelity scores
    • Fidelity Index

    Cite this

    Dogar, Omara ; Boehnke, Jan ; Lorencatto, Fabiana ; Sheldon, Trevor A. ; Siddiqi, Kamran. / Measuring fidelity to behavioural support delivery for smoking cessation and its association with outcomes. In: Addiction. 2019.
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    abstract = "Background and aims: Behavioural support increases smoking cessation in clinical settings, but effect sizes differ among providers, possibly due to variations in delivery. This study evaluates a measure (“fidelity index”) intended to capture fidelity to delivery of content-based and interactionbased items of a Behavioural Support (BS) for smoking cessation and the association of fidelity with quit rates.Methods: A fidelity index for scoring the adherence and quality domains of a specific BS intervention, 5As for quit, was developed by classifying the intervention components using the taxonomy of Behaviour Change Techniques. The index was applied to code 154 BS sessions audiotaped across 18 chest clinics in Pakistan to assess their fidelity and explore reliability of coding. The association between intervention fidelity and successful quit achieved by the same providers in a previous study was explored using regression analysis.Results: The index represented two domains: adherence to delivery of content-based activities of 5As (37 items) and quality of interaction-based activities (8 items). The inter-coder reliability was good for content-based (average Krippendorff's α = 0.80) and moderate for interactionbased (average Krippendorff's α = 0.66) items. About 70{\%} (Intra-class Correlation Coefficient: adherence scores = 0.72, quality scores = 0.71) of variation in BS delivery was contributed by providers, which increased to 97{\%} (g-coefficient: adherence scores = 0.973, quality scores = 0.974) after accounting for other sources of variation. Higher quit rates were positively associated with average quality scores (risk ratio: 2.15; 95{\%} CI, 1.43 to 3.24), but negatively associated with average adherence scores (risk ratio: 0.55; 95{\%} CI, 0.40 to 0.77), within services.Conclusions: The fidelity index is a reliable measure for quantifying intervention fidelity of delivering smoking cessation behavioural support. Recommended revisions of the fidelity index include incorporation of additional interaction-based items, like the relational techniques used in motivational interviewing.",
    keywords = "Behavioural Support, Behaviour Change Techniques, Smoking cessation, Intervention fidelity, Fidelity scores, Fidelity Index",
    author = "Omara Dogar and Jan Boehnke and Fabiana Lorencatto and Sheldon, {Trevor A.} and Kamran Siddiqi",
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    Measuring fidelity to behavioural support delivery for smoking cessation and its association with outcomes. / Dogar, Omara (Lead / Corresponding author); Boehnke, Jan; Lorencatto, Fabiana; Sheldon, Trevor A.; Siddiqi, Kamran.

    In: Addiction, 08.09.2019.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Measuring fidelity to behavioural support delivery for smoking cessation and its association with outcomes

    AU - Dogar, Omara

    AU - Boehnke, Jan

    AU - Lorencatto, Fabiana

    AU - Sheldon, Trevor A.

    AU - Siddiqi, Kamran

    N1 - This article is protected by copyright. All rights reserved.

    PY - 2019/9/8

    Y1 - 2019/9/8

    N2 - Background and aims: Behavioural support increases smoking cessation in clinical settings, but effect sizes differ among providers, possibly due to variations in delivery. This study evaluates a measure (“fidelity index”) intended to capture fidelity to delivery of content-based and interactionbased items of a Behavioural Support (BS) for smoking cessation and the association of fidelity with quit rates.Methods: A fidelity index for scoring the adherence and quality domains of a specific BS intervention, 5As for quit, was developed by classifying the intervention components using the taxonomy of Behaviour Change Techniques. The index was applied to code 154 BS sessions audiotaped across 18 chest clinics in Pakistan to assess their fidelity and explore reliability of coding. The association between intervention fidelity and successful quit achieved by the same providers in a previous study was explored using regression analysis.Results: The index represented two domains: adherence to delivery of content-based activities of 5As (37 items) and quality of interaction-based activities (8 items). The inter-coder reliability was good for content-based (average Krippendorff's α = 0.80) and moderate for interactionbased (average Krippendorff's α = 0.66) items. About 70% (Intra-class Correlation Coefficient: adherence scores = 0.72, quality scores = 0.71) of variation in BS delivery was contributed by providers, which increased to 97% (g-coefficient: adherence scores = 0.973, quality scores = 0.974) after accounting for other sources of variation. Higher quit rates were positively associated with average quality scores (risk ratio: 2.15; 95% CI, 1.43 to 3.24), but negatively associated with average adherence scores (risk ratio: 0.55; 95% CI, 0.40 to 0.77), within services.Conclusions: The fidelity index is a reliable measure for quantifying intervention fidelity of delivering smoking cessation behavioural support. Recommended revisions of the fidelity index include incorporation of additional interaction-based items, like the relational techniques used in motivational interviewing.

    AB - Background and aims: Behavioural support increases smoking cessation in clinical settings, but effect sizes differ among providers, possibly due to variations in delivery. This study evaluates a measure (“fidelity index”) intended to capture fidelity to delivery of content-based and interactionbased items of a Behavioural Support (BS) for smoking cessation and the association of fidelity with quit rates.Methods: A fidelity index for scoring the adherence and quality domains of a specific BS intervention, 5As for quit, was developed by classifying the intervention components using the taxonomy of Behaviour Change Techniques. The index was applied to code 154 BS sessions audiotaped across 18 chest clinics in Pakistan to assess their fidelity and explore reliability of coding. The association between intervention fidelity and successful quit achieved by the same providers in a previous study was explored using regression analysis.Results: The index represented two domains: adherence to delivery of content-based activities of 5As (37 items) and quality of interaction-based activities (8 items). The inter-coder reliability was good for content-based (average Krippendorff's α = 0.80) and moderate for interactionbased (average Krippendorff's α = 0.66) items. About 70% (Intra-class Correlation Coefficient: adherence scores = 0.72, quality scores = 0.71) of variation in BS delivery was contributed by providers, which increased to 97% (g-coefficient: adherence scores = 0.973, quality scores = 0.974) after accounting for other sources of variation. Higher quit rates were positively associated with average quality scores (risk ratio: 2.15; 95% CI, 1.43 to 3.24), but negatively associated with average adherence scores (risk ratio: 0.55; 95% CI, 0.40 to 0.77), within services.Conclusions: The fidelity index is a reliable measure for quantifying intervention fidelity of delivering smoking cessation behavioural support. Recommended revisions of the fidelity index include incorporation of additional interaction-based items, like the relational techniques used in motivational interviewing.

    KW - Behavioural Support

    KW - Behaviour Change Techniques

    KW - Smoking cessation

    KW - Intervention fidelity

    KW - Fidelity scores

    KW - Fidelity Index

    U2 - 10.1111/add.14804

    DO - 10.1111/add.14804

    M3 - Article

    JO - Addiction

    JF - Addiction

    SN - 0965-2140

    ER -