title: Enhanced fidelity of an educational intervention on skin self-examination through surveillance and standardization.
abstract: BACKGROUND
  Melanoma can metastasize but is often successfully treated when discovered in an early stage. Melanoma patients and their skin check partners can learn skin self-examination (SSE) skills and these skills can be improved by practice. The purpose of this study is to determine the degree of fidelity with which educational in-person SSE intervention can be delivered by trained research coordinators to patients at risk of developing another melanoma and their skin check partners.
  
  
  METHODS
  The in-person intervention was performed in two iterations. In phase 1 (2006-2008), the research coordinators were trained to perform the intervention using a written script. In phase 2 (2011-2013), the research coordinators were trained to perform the intervention with a PowerPoint aid. Each research coordinator was individually counseled by one of the authors (KM) to insure standardization and enhance fidelity of intervention delivery. Phase 1 and Phase 2 were compared on 16 fidelity components. Further, Phase 2 fidelity was assessed by comparing mean scores of fidelity across the five research coordinators who delivered the intervention.
  
  
  RESULTS
  Phase 2, which utilized a PowerPoint aid, was delivered with a higher degree of fidelity compared to phase 1with four fidelity components with significantly higher fidelity than Phase 1: 1) Explained details of melanoma,χ2(1, n = 199)= 96.31,p< .001, 2) Discussed when to call doctor,χ2(1, n = 199) = 53.68,p< .001 3) Explained assessment at month 1,χ2(1, n = 199)= 12.39,p< .01, and 4) Explained assessment at month 2,χ2(1, n = 199) = 117.75,p< .001. Further, no significant differences on mean fidelity were found across research coordinators in Phase 2.
  
  
  CONCLUSIONS
  When using the PowerPoint aide, the research coordinators delivered the intervention with high fidelity (all scores >14) and there were no mean differences in fidelity across research coordinators, indicating consistency in fidelity. This can be attributed to the standardization and cueing that the PowerPoint program offered. Supervision was also a key component in establishing and maintaining fidelity of the patient educational process. This method of intervention delivery enables trained healthcare professionals to deliver an educational intervention in an effective, consistent manner.
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Rikki
authors.initials: R
authors.lastname: Gaber
authors.affiliation: Biobehavioral Health and Prevention Research Center, The Pennsylvania State University, University Park, State College, PA, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Mallett
authors.affiliation: Biobehavioral Health and Prevention Research Center, The Pennsylvania State University, University Park, State College, PA, USA.
authors.forename: Brittney
authors.initials: B
authors.lastname: Hultgren
authors.affiliation: Biobehavioral Health and Prevention Research Center, The Pennsylvania State University, University Park, State College, PA, USA.
authors.forename: Rob
authors.initials: R
authors.lastname: Turrisi
authors.affiliation: Robert Lurie Cancer Center, Northwestern University, Chicago, IL, USA.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Gilbertsen
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Martini
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: June K
authors.initials: JK
authors.lastname: Robinson
keywords: Educational intervention; Fidelity of delivery; Melanoma; Skin cancer; Skin self-examination