Key result
Primary care nurses achieve ~88% fidelity delivering the Activate behavioral intervention.
Why the study?
The study was conducted to evaluate the fidelity and quality of delivery of a nurse-led physical activity intervention (Activate) in patients at risk for cardiovascular diseases, alongside nurses' beliefs about delivering it.
Observational (n=20)
Yes
Assessing intervention fidelity shows that while nurses can deliver general behavioral intervention components with high fidelity, specific behavioral change techniques have moderate fidelity and variations in quality may dilute intervention effectiveness.
High fidelity supports nurse-led feasibility in primary care; moderate technique fidelity may dilute impact and leaves optimization open for trials.
OBJECTIVE: To evaluate the fidelity of delivery of a nurse-led intervention to enhance physical activity in patients at risk for cardiovascular diseases, the Activate intervention, by assessing: (1) self-reported fidelity of delivery; (2) observed fidelity of delivery; (3) quality of delivery of the Activate intervention and (4) nurses' beliefs about their capability, motivation, confidence and effectiveness towards delivering the Activate intervention, including behavioural change techniques. DESIGN: An observational study. SETTING: General practices in the Netherlands. PARTICIPANTS: Primary care nurses (n=20) from 16 general practices. PRIMARY AND SECONDARY OUTCOME MEASURES: Nurses' self-reported fidelity was evaluated using checklists (n=282), and the observed fidelity and quality of delivery were examined using audiorecordings of consultations of the delivery of the Activate intervention (n=42). Nurses' beliefs towards delivering the intervention were assessed using questionnaires (n=72). RESULTS: The self-reported fidelity was 88.1% and observed fidelity was 85.4%, representing high fidelity. The observed fidelity of applied behavioural change techniques was moderate (75.0%). The observed quality of delivery was sufficient and varied among nurses (mean 2.9; SD 4.4; range 0-4). Nurses' beliefs about their capability, motivation, confidence and effectiveness towards delivering the intervention increased over time. CONCLUSIONS: Nurses delivered most intervention components as intended with sufficient quality. Nurses believed they were capable, motivated and confident to deliver the intervention. They believed the intervention was effective to increase patients' physical activity level. Despite the high fidelity and moderate fidelity of applied behavioural change techniques, the varying quality of delivery within and across nurses might have diluted the effectiveness of the Activate intervention. TRIAL REGISTRATION NUMBER: NCT02725203.
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Westland et al. (2021) conducted an observational in Primary care nurses delivering a behavioral change intervention to patients at risk for cardiovascular disease (n=20). Activate intervention delivery was evaluated on Self-reported fidelity of delivery of the intervention components. Primary care nurses delivered the Activate intervention components with 88.1% self-reported and 85.4% observed fidelity, although fidelity for applied behavioral change techniques was moderate at 75.0%.
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