Article type
Year
Abstract
Background: Intervention fidelity is the degree to which an intervention is delivered as intended. Recent evidence indicates that intervention fidelity should be part of the appraisal of randomized controlled trials (RCTs) of non-pharmacological interventions. It is not known how systematic reviews (SRs) of non-pharmacological RCTs in asthma education evaluate intervention fidelity and which specific fidelity dimensions have been reported.
Objectives: To describe the reporting of intervention fidelity in SRs of RCTs assessing the effectiveness of asthma education.
Methods: Relevant SRs of the effectiveness of asthma education in children and adult populations were identified through searches in seven electronic databases. Two independent reviewers assessed eligibility of SRs and completed data extraction. The Treatment Fidelity Assessment Grid was used to evaluate the reporting of five dimensions of treatment fidelity in the SRs: 1) fidelity to theory; 2) provider training; 3) treatment implementation; 4) treatment receipt; and 5) treatment enactment. Results were summarized descriptively.
Results: From 5218 citations, 24 SRs of asthma education (10 Cochrane versus 14 non-Cochrane reviews) were included. The majority of reviews (n = 20) assessed at least one aspect of treatment fidelity of individual RCTs. The dimensions of treatment fidelity most frequently assessed in SRs were treatment implementation (n = 17) and provider training (n = 11); treatment receipt (n = 6), theoretical fidelity (n = 4) and treatment enactment (n = 4) were less frequently reported. No statistical associations between these domains and SRs characteristics (type, quality and direction of results) were found.
Conclusions: Current SRs of asthma education reveal inconsistent reports of intervention fidelity in RCTs. This limits the translation of results into clinical practice and may influence the interpretation of effectiveness. Using standardized models of fidelity assessment in SRs will ensure that key features of non-pharmacological interventions are understood, appraised appropriately, and examined in relation with therapeutic change and outcome results.
Objectives: To describe the reporting of intervention fidelity in SRs of RCTs assessing the effectiveness of asthma education.
Methods: Relevant SRs of the effectiveness of asthma education in children and adult populations were identified through searches in seven electronic databases. Two independent reviewers assessed eligibility of SRs and completed data extraction. The Treatment Fidelity Assessment Grid was used to evaluate the reporting of five dimensions of treatment fidelity in the SRs: 1) fidelity to theory; 2) provider training; 3) treatment implementation; 4) treatment receipt; and 5) treatment enactment. Results were summarized descriptively.
Results: From 5218 citations, 24 SRs of asthma education (10 Cochrane versus 14 non-Cochrane reviews) were included. The majority of reviews (n = 20) assessed at least one aspect of treatment fidelity of individual RCTs. The dimensions of treatment fidelity most frequently assessed in SRs were treatment implementation (n = 17) and provider training (n = 11); treatment receipt (n = 6), theoretical fidelity (n = 4) and treatment enactment (n = 4) were less frequently reported. No statistical associations between these domains and SRs characteristics (type, quality and direction of results) were found.
Conclusions: Current SRs of asthma education reveal inconsistent reports of intervention fidelity in RCTs. This limits the translation of results into clinical practice and may influence the interpretation of effectiveness. Using standardized models of fidelity assessment in SRs will ensure that key features of non-pharmacological interventions are understood, appraised appropriately, and examined in relation with therapeutic change and outcome results.