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

Research output: Contribution to journalArticlepeer-review

6 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 languageEnglish
Article number1112
JournalBMC Public Health
Volume22
Issue number1
DOIs
Publication statusPublished - 3 Jun 2022

Bibliographical 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’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).

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

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