Online group-based Acceptance and Commitment Therapy for stroke survivors: a study of fidelity of delivery within the Wellbeing After Stroke study.

Abstract Objectives To explore whether practitioners can deliver the Acceptance and Commitment Therapy-based Wellbeing After Stroke intervention with fidelity to both the clinical protocol and the Acceptance and Commitment therapy model. Design Observational fidelity study, embedded within the Wellbeing After Stroke study. Setting: online groups. UK. Participants Practitioners employed by the Stroke Association, trained to deliver the intervention. Measures 1) a bespoke Wellbeing After Stroke fidelity tool to assess fidelity to dose, duration and content of intervention sessions, self-completed by practitioners and a sub-set completed by researchers based on video recordings. We calculated inter-rater reliability of researchers and practitioners. 2) Acceptance and Commitment Therapy-Fidelity Measure to assess fidelity to the Acceptance and Commitment Therapy model, completed by researchers on the sub-set of recorded sessions. Results Seven practitioners delivered the Wellbeing After Stroke intervention to three groups of stroke survivors. The planned dose of the intervention was delivered, with duration slightly longer than planned. Practitioners delivered the intervention with high fidelity to protocol: 92–100% of content delivered, as measured by the Wellbeing After Stroke fidelity tool, once reliability was established. Some practitioners delivered the intervention with fidelity to the Acceptance and Commitment Therapy model. Conclusions Trained and supervised practitioners can deliver an online, group Acceptance and Commitment Therapy-based intervention to stroke survivors with high fidelity to protocol. Improving training may increase consistency with the Acceptance and Commitment Therapy model. The ACT-Fidelity Measure can be used to measure consistency of delivery of protocolised, group interventions, but adaptations would increase suitability to context.