Towards a programme theory for fidelity in the evaluation of complex interventions.

Journal article


Masterson-Algar, P., Burton, C., Rycroft-Malone, J., Sackley, C.M. and Walker, M.F. 2014. Towards a programme theory for fidelity in the evaluation of complex interventions. Journal of Evaluation in Clinical Practice . 20 (4), pp. 445 - 452.
AuthorsMasterson-Algar, P., Burton, C., Rycroft-Malone, J., Sackley, C.M. and Walker, M.F.
Abstract

Rationale, aims and objectives: This paper addresses the challenge of investigating fidelity in the implementation of a complex rehabilitation intervention designed to increase the level of independence in personal activities of daily living of stroke patients living in UK care homes. A programme theory of intervention fidelity was constructed to underpin a process evaluation running alongside a cluster randomized trial of the rehabilitation intervention.

Methods: The programme theory has been constructed drawing on principles of realist evaluation. Using data from in-depth semi-structured interviews (n = 17) with all occupational therapists (OTs) and critical incident reports from the trial (n = 20), and drawing from frameworks for implementation, the programme theory was developed.

Results: The programme theory incorporates four potential mechanisms through which fidelity within the trial can be investigated. These four programme theory areas are (1) the balancing of research and professional requirements that therapists performed in a number of areas while delivering the study interventions; (2) the OTs rapport building with care home staff; (3) the work focused on re-engineering the personal environments of care home patients; and (4) the learning about the intervention within the context of the trial and its impacts over time.

Conclusions: These findings characterize the real-world nature of fidelity within intervention research, and specifically the negotiated nature of implementation within clinical settings, including individual patients' needs. This research adds to the evidence base because current frameworks for fidelity neglect the importance of learning over time of individuals and across the time span of a trial.

KeywordsComplex interventions; Fidelity; Learning curve; Process evaluation; Programme theory; Realist evaluation
Year2014
JournalJournal of Evaluation in Clinical Practice
Journal citation20 (4), pp. 445 - 452
PublisherJohn Wiley & Sons Ltd
ISSN1356-1294
Digital Object Identifier (DOI)doi:10.1111/jep.12174
Official URLhttps://doi.org/10.1111/jep.12174
Publication dates
Online19 May 2014
PrintAug 2014
Publication process dates
Accepted09 Apr 2014
Deposited15 Jun 2020
References

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