title: Evaluation of the fidelity of an interactive face-to-face educational intervention to improve general practitioner management of back pain.
abstract: OBJECTIVE
  Implementation intervention effects can only be fully realised and understood if they are faithfully delivered. However the evaluation of implementation intervention fidelity is not commonly undertaken. The IMPLEMENT intervention was designed to improve the management of low back pain by general medical practitioners. It consisted of a two-session interactive workshop, including didactic presentations and small group discussions by trained facilitators. This study aimed to evaluate the fidelity of the IMPLEMENT intervention by assessing: (1) observed facilitator adherence to planned behaviour change techniques (BCTs); (2) comparison of observed and self-reported adherence to planned BCTs and (3) variation across different facilitators and different BCTs.
  
  
  METHODS
  The study compared planned and actual, and observed versus self-assessed delivery of BCTs during the IMPLEMENT workshops.
  
  
  METHODS
  Workshop sessions were audiorecorded and transcribed verbatim. Observed adherence of facilitators to the planned intervention was assessed by analysing the workshop transcripts in terms of BCTs delivered. Self-reported adherence was measured using a checklist completed at the end of each workshop session and was compared with the 'gold standard' of observed adherence using sensitivity and specificity analyses.
  
  
  RESULTS
  The overall observed adherence to planned BCTs was 79%, representing moderate-to-high intervention fidelity. There was no significant difference in adherence to BCTs between the facilitators. Sensitivity of self-reported adherence was 95% (95% CI 88 to 98) and specificity was 30% (95% CI 11 to 60).
  
  
  CONCLUSIONS
  The findings suggest that the IMPLEMENT intervention was delivered with high levels of adherence to the planned intervention protocol.
  
  
  BACKGROUND
  The IMPLEMENT trial was registered in the Australian New Zealand Clinical Trials Registry, ACTRN012606000098538 (http://www.anzctr.org.au/trial_view.aspx?ID=1162).
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
authors.forename: Simon D
authors.initials: SD
authors.lastname: French
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Sally E
authors.initials: SE
authors.lastname: Green
authors.affiliation: Division of Health Services Research & Management, School of Health Sciences, City University London, London, UK.
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Francis
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Monash Department of Clinical Epidemiology, Cabrini Hospital, Melbourne, Victoria, Australia.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Denise A
authors.initials: DA
authors.lastname: O'Connor
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.affiliation: Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
mesh_terms: D001315:Australia; D002983:Clinical Competence / Q000592:standards; D004503:Education, Medical, Graduate / Q000379:methods*; D058006:General Practice / Q000193:education* / Q000592:standards; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D057566:Self Report
keywords: PRIMARY CARE