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Table 1 Treatment fidelity components and assessment approaches

From: Fidelity is not easy! Challenges and guidelines for assessing fidelity in complex interventions

Treatment fidelity components [3] Approach to fidelity assessment Supplemental appendix
Fidelity of treatment design   
 • Intervention is defined and operationalized consistent with its underlying theory • Intervention approach and components designed with careful consideration of underlying theory n/a
Fidelity delivery   
 • Adherence to protocol (components, timing, etc.) • Delivery checklist completed by the same administrative staff person in each workshop to verify components were delivered as per protocol 1
 • Consistent delivery within study arm • Debriefings of workshop teams after each workshop regarding any deviations from protocol 1
 • Minimize contamination • Study designed to minimize contamination between study arms by (a) delivering separate workshops to participants in the basic and enhanced study arms and (b) asking participants not to talk about study details to persons external to their facilities n/a
Fidelity receipt   
 • Participants understood/can use intervention components • Workshop attendance lists used to assess unit representation in each workshop (receipt only) n/a
• Coding of goal setting worksheets completed at 1st workshop for evidence of comprehension of goal setting and strategy development (receipt only) 2
Fidelity enactment
 • Engagement in INFORM activities (adherence)
• Exit survey data from workshop participants
• Structured observation of workshop 2 team progress presentations (showing work to date)
• Analysis of slide decks teams were asked to prepare showing progress to date 4
• Mid- and post-intervention focus groups 5
• Expert assessment (enactment only) 6
  1. Added part way through the intervention when mid-intervention focus groups were cancelled; planned but not carried out. These changes are discussed in the results section