Delivery fidelity of the REACT (REtirement in ACTion) physical activity and behaviour maintenance intervention for community dwelling older people with mobility limitations

Rosina Cross; Colin J. Greaves; Janet Withall; W. Jack Rejeski; Afroditi Stathi

doi:10.1186/s12889-022-13496-z

Delivery fidelity of the REACT (REtirement in ACTion) physical activity and behaviour maintenance intervention for community dwelling older people with mobility limitations

Rosina Cross, Colin J. Greaves, Janet Withall, W. Jack Rejeski, Afroditi Stathi

Department for Health

Research output: Contribution to journal › Article › peer-review

3 Citations (SciVal)

Abstract

Background

Fidelity assessment of behaviour change interventions is vital to understanding trial outcomes. This study assesses the delivery fidelity of behaviour change techniques used in the Retirement in ACTion (REACT) randomised controlled trial. REACT is a community-based physical activity (PA) and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years) at high risk of mobility-related disability in the UK.
Methods

The delivery fidelity of intervention behaviour change techniques and delivery processes were assessed using multi-observer coding of purposively sampled in-vivo audio recordings (n = 25) of health behaviour maintenance sessions over 12-months. Delivery fidelity was scored using a modified Dreyfus scale (scores 0–5) to assess competence and completeness of delivery for each technique and delivery process. “Competent delivery” was defined as a score of 3 points or more for each item. Examples of competent intervention delivery were identified to inform recommendations for future programme delivery and training.
Results

The mean intervention fidelity score was 2.5 (SD 0.45) with delivery fidelity varying between techniques/processes and intervention groups. Person-centred delivery, Facilitating Enjoyment and Promoting Autonomy were delivered competently (scoring 3.0 or more). There was scope for improvement (score 2.0—2.9) in Monitoring Progress (Acknowledging and Reviewing), Self-Monitoring, Monitoring Progress (Eliciting Benefits of Physical Activity), Goal Setting and Action Planning, Modelling, Supporting Self-Efficacy for Physical Activity and Supporting Relatedness. Managing Setbacks and Problem Solving was delivered with low fidelity. Numerous examples of both good and sub-optimal practice were identified.
Conclusions

This study highlights successes and improvements needed to enhance delivery fidelity in future implementation of the behavioural maintenance programme of the REACT intervention. Future training of REACT session leaders and assessment of delivery fidelity needs to focus on the delivery of Goal setting and Action Planning, Modelling, Supporting Relatedness, Supporting Self-Efficacy for Physical Activity, and Managing Setbacks/ Problem Solving.

Original language	English
Article number	1112
Journal	BMC Public Health
Volume	22
Issue number	1
DOIs	https://doi.org/10.1186/s12889-022-13496-z
Publication status	Published - 3 Jun 2022

Keywords

Behaviour change
Behaviour change techniques
Behavioural intervention
Older adults
Physical activity
Process evaluation
Randomised controlled trial

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12889-022-13496-zLicence: CC BY

Cite this

@article{b5e7e29c32d446f2aea1fedd1da744e3,

title = "Delivery fidelity of the REACT (REtirement in ACTion) physical activity and behaviour maintenance intervention for community dwelling older people with mobility limitations",

abstract = "BackgroundFidelity assessment of behaviour change interventions is vital to understanding trial outcomes. This study assesses the delivery fidelity of behaviour change techniques used in the Retirement in ACTion (REACT) randomised controlled trial. REACT is a community-based physical activity (PA) and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years) at high risk of mobility-related disability in the UK.MethodsThe delivery fidelity of intervention behaviour change techniques and delivery processes were assessed using multi-observer coding of purposively sampled in-vivo audio recordings (n = 25) of health behaviour maintenance sessions over 12-months. Delivery fidelity was scored using a modified Dreyfus scale (scores 0–5) to assess competence and completeness of delivery for each technique and delivery process. “Competent delivery” was defined as a score of 3 points or more for each item. Examples of competent intervention delivery were identified to inform recommendations for future programme delivery and training.ResultsThe mean intervention fidelity score was 2.5 (SD 0.45) with delivery fidelity varying between techniques/processes and intervention groups. Person-centred delivery, Facilitating Enjoyment and Promoting Autonomy were delivered competently (scoring 3.0 or more). There was scope for improvement (score 2.0—2.9) in Monitoring Progress (Acknowledging and Reviewing), Self-Monitoring, Monitoring Progress (Eliciting Benefits of Physical Activity), Goal Setting and Action Planning, Modelling, Supporting Self-Efficacy for Physical Activity and Supporting Relatedness. Managing Setbacks and Problem Solving was delivered with low fidelity. Numerous examples of both good and sub-optimal practice were identified.ConclusionsThis study highlights successes and improvements needed to enhance delivery fidelity in future implementation of the behavioural maintenance programme of the REACT intervention. Future training of REACT session leaders and assessment of delivery fidelity needs to focus on the delivery of Goal setting and Action Planning, Modelling, Supporting Relatedness, Supporting Self-Efficacy for Physical Activity, and Managing Setbacks/ Problem Solving.",

keywords = "Behaviour change, Behaviour change techniques, Behavioural intervention, Older adults, Physical activity, Process evaluation, Randomised controlled trial",

author = "Rosina Cross and Greaves, {Colin J.} and Janet Withall and Rejeski, {W. Jack} and Afroditi Stathi",

note = "Funding Information: This work was supported by the National Institute for Health Research, Public Health Research Programme (13/164/51). The corresponding author (RC) was supported in their research by a PhD studentship funded by the University of Bath. We wish to express our thanks to the entire REACT research team, the research participants, the Clinical Research Networks at each REACT site and all the GP practices and community organisations who supported REACT recruitment. Delivery of the REACT programme was only possible due to the support of our partners Bath and North East Somerset Council; Exeter and Solihull City Councils; Westbank Charity; St Monica Trust, Bristol; Bristol Ageing Better; St John{\textquoteright}s Hospital, Bath; Age UK Birmingham; Agewell, West Midlands; Sandwell and West Birmingham Hospitals NHS Trust; the Portway Lifestyle Centre and Solihull Borough Council, Birmingham. Funding Information: This work was supported by the National Institute for Health Research, Public Health Research Programme (13/164/51). The corresponding author (RC) was supported in their research by a PhD studentship funded by the University of Bath. We wish to express our thanks to the entire REACT research team, the research participants, the Clinical Research Networks at each REACT site and all the GP practices and community organisations who supported REACT recruitment. Delivery of the REACT programme was only possible due to the support of our partners Bath and North East Somerset Council; Exeter and Solihull City Councils; Westbank Charity; St Monica Trust, Bristol; Bristol Ageing Better; St John{\textquoteright}s Hospital, Bath; Age UK Birmingham; Agewell, West Midlands; Sandwell and West Birmingham Hospitals NHS Trust; the Portway Lifestyle Centre and Solihull Borough Council, Birmingham. Funding Information: The REACT study was funded by the National Institute for Health Research (NIHR) – Public Health Research Programme (13/164/51). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The study was generously supported by the Clinical Research Network at each site. The funder approved the study design but had no role in data collection, data analysis, data interpretation and publications related to the REACT study dataset. The corresponding author was funded by a University of Bath PhD studentship. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = jun,

day = "3",

doi = "10.1186/s12889-022-13496-z",

language = "English",

volume = "22",

journal = "BMC Public Health",

issn = "1471-2458",

publisher = "BioMed Central",

number = "1",

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TY - JOUR

T1 - Delivery fidelity of the REACT (REtirement in ACTion) physical activity and behaviour maintenance intervention for community dwelling older people with mobility limitations

AU - Cross, Rosina

AU - Greaves, Colin J.

AU - Withall, Janet

AU - Rejeski, W. Jack

AU - Stathi, Afroditi

N1 - Funding Information: This work was supported by the National Institute for Health Research, Public Health Research Programme (13/164/51). The corresponding author (RC) was supported in their research by a PhD studentship funded by the University of Bath. We wish to express our thanks to the entire REACT research team, the research participants, the Clinical Research Networks at each REACT site and all the GP practices and community organisations who supported REACT recruitment. Delivery of the REACT programme was only possible due to the support of our partners Bath and North East Somerset Council; Exeter and Solihull City Councils; Westbank Charity; St Monica Trust, Bristol; Bristol Ageing Better; St John’s Hospital, Bath; Age UK Birmingham; Agewell, West Midlands; Sandwell and West Birmingham Hospitals NHS Trust; the Portway Lifestyle Centre and Solihull Borough Council, Birmingham. Funding Information: This work was supported by the National Institute for Health Research, Public Health Research Programme (13/164/51). The corresponding author (RC) was supported in their research by a PhD studentship funded by the University of Bath. We wish to express our thanks to the entire REACT research team, the research participants, the Clinical Research Networks at each REACT site and all the GP practices and community organisations who supported REACT recruitment. Delivery of the REACT programme was only possible due to the support of our partners Bath and North East Somerset Council; Exeter and Solihull City Councils; Westbank Charity; St Monica Trust, Bristol; Bristol Ageing Better; St John’s Hospital, Bath; Age UK Birmingham; Agewell, West Midlands; Sandwell and West Birmingham Hospitals NHS Trust; the Portway Lifestyle Centre and Solihull Borough Council, Birmingham. Funding Information: The REACT study was funded by the National Institute for Health Research (NIHR) – Public Health Research Programme (13/164/51). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The study was generously supported by the Clinical Research Network at each site. The funder approved the study design but had no role in data collection, data analysis, data interpretation and publications related to the REACT study dataset. The corresponding author was funded by a University of Bath PhD studentship. Publisher Copyright: © 2022, The Author(s).

PY - 2022/6/3

Y1 - 2022/6/3

N2 - BackgroundFidelity assessment of behaviour change interventions is vital to understanding trial outcomes. This study assesses the delivery fidelity of behaviour change techniques used in the Retirement in ACTion (REACT) randomised controlled trial. REACT is a community-based physical activity (PA) and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years) at high risk of mobility-related disability in the UK.MethodsThe delivery fidelity of intervention behaviour change techniques and delivery processes were assessed using multi-observer coding of purposively sampled in-vivo audio recordings (n = 25) of health behaviour maintenance sessions over 12-months. Delivery fidelity was scored using a modified Dreyfus scale (scores 0–5) to assess competence and completeness of delivery for each technique and delivery process. “Competent delivery” was defined as a score of 3 points or more for each item. Examples of competent intervention delivery were identified to inform recommendations for future programme delivery and training.ResultsThe mean intervention fidelity score was 2.5 (SD 0.45) with delivery fidelity varying between techniques/processes and intervention groups. Person-centred delivery, Facilitating Enjoyment and Promoting Autonomy were delivered competently (scoring 3.0 or more). There was scope for improvement (score 2.0—2.9) in Monitoring Progress (Acknowledging and Reviewing), Self-Monitoring, Monitoring Progress (Eliciting Benefits of Physical Activity), Goal Setting and Action Planning, Modelling, Supporting Self-Efficacy for Physical Activity and Supporting Relatedness. Managing Setbacks and Problem Solving was delivered with low fidelity. Numerous examples of both good and sub-optimal practice were identified.ConclusionsThis study highlights successes and improvements needed to enhance delivery fidelity in future implementation of the behavioural maintenance programme of the REACT intervention. Future training of REACT session leaders and assessment of delivery fidelity needs to focus on the delivery of Goal setting and Action Planning, Modelling, Supporting Relatedness, Supporting Self-Efficacy for Physical Activity, and Managing Setbacks/ Problem Solving.

AB - BackgroundFidelity assessment of behaviour change interventions is vital to understanding trial outcomes. This study assesses the delivery fidelity of behaviour change techniques used in the Retirement in ACTion (REACT) randomised controlled trial. REACT is a community-based physical activity (PA) and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years) at high risk of mobility-related disability in the UK.MethodsThe delivery fidelity of intervention behaviour change techniques and delivery processes were assessed using multi-observer coding of purposively sampled in-vivo audio recordings (n = 25) of health behaviour maintenance sessions over 12-months. Delivery fidelity was scored using a modified Dreyfus scale (scores 0–5) to assess competence and completeness of delivery for each technique and delivery process. “Competent delivery” was defined as a score of 3 points or more for each item. Examples of competent intervention delivery were identified to inform recommendations for future programme delivery and training.ResultsThe mean intervention fidelity score was 2.5 (SD 0.45) with delivery fidelity varying between techniques/processes and intervention groups. Person-centred delivery, Facilitating Enjoyment and Promoting Autonomy were delivered competently (scoring 3.0 or more). There was scope for improvement (score 2.0—2.9) in Monitoring Progress (Acknowledging and Reviewing), Self-Monitoring, Monitoring Progress (Eliciting Benefits of Physical Activity), Goal Setting and Action Planning, Modelling, Supporting Self-Efficacy for Physical Activity and Supporting Relatedness. Managing Setbacks and Problem Solving was delivered with low fidelity. Numerous examples of both good and sub-optimal practice were identified.ConclusionsThis study highlights successes and improvements needed to enhance delivery fidelity in future implementation of the behavioural maintenance programme of the REACT intervention. Future training of REACT session leaders and assessment of delivery fidelity needs to focus on the delivery of Goal setting and Action Planning, Modelling, Supporting Relatedness, Supporting Self-Efficacy for Physical Activity, and Managing Setbacks/ Problem Solving.

KW - Behaviour change

KW - Behaviour change techniques

KW - Behavioural intervention

KW - Older adults

KW - Physical activity

KW - Process evaluation

KW - Randomised controlled trial

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U2 - 10.1186/s12889-022-13496-z

DO - 10.1186/s12889-022-13496-z

M3 - Article

SN - 1471-2458

VL - 22

JO - BMC Public Health

JF - BMC Public Health

IS - 1

M1 - 1112

ER -

Delivery fidelity of the REACT (REtirement in ACTion) physical activity and behaviour maintenance intervention for community dwelling older people with mobility limitations

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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