title: Assessing intervention fidelity in a multi-level, multi-component, multi-site program: the Children's Healthy Living (CHL) program.
abstract: Addressing complex chronic disease prevention, like childhood obesity, requires a multi-level, multi-component culturally relevant approach with broad reach. Models are lacking to guide fidelity monitoring across multiple levels, components, and sites engaged in such interventions. The aim of this study is to describe the fidelity-monitoring approach of The Children's Healthy Living (CHL) Program, a multi-level multi-component intervention in five Pacific jurisdictions. A fidelity-monitoring rubric was developed. About halfway during the intervention, community partners were randomly selected and interviewed independently by local CHL staff and by Coordinating Center representatives to assess treatment fidelity. Ratings were compared and discussed by local and Coordinating Center staff. There was good agreement between the teams (Kappa = 0.50, p < 0.001), and intervention improvement opportunities were identified through data review and group discussion. Fidelity for the multi-level, multi-component, multi-site CHL intervention was successfully assessed, identifying adaptations as well as ways to improve intervention delivery prior to the end of the intervention.
authors.affiliation: College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Butel
authors.affiliation: Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI USA.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Braun
authors.affiliation: College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Novotny
authors.affiliation: University of Guam, Mangilao, Guam.
authors.forename: Mark
authors.initials: M
authors.lastname: Acosta
authors.affiliation: Northern Marianas College, Saipan, Northern Mariana Islands.
authors.forename: Rose
authors.initials: R
authors.lastname: Castro
authors.affiliation: American Samoa Community College, Mapusaga, American Samoa.
authors.forename: Travis
authors.initials: T
authors.lastname: Fleming
authors.affiliation: University of Alaska at Fairbanks, Fairbanks, AK USA.
authors.forename: Julianne
authors.initials: J
authors.lastname: Powers
authors.affiliation: Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI USA.
authors.forename: Claudio R
authors.initials: CR
authors.lastname: Nigg
keywords: Childhood obesity; Community-based research; Ecological model; Implementation fidelity