2.50
Hdl Handle:
http://hdl.handle.net/10755/211583
Type:
Research Study
Title:
ESTABLISHING TREATMENT FIDELITY IN A WEB-BASED BEHAVIORAL INTERVENTION STUDY
Abstract:
Purpose/Aims:  The purpose of this paper is to describe a methodology for ensuring treatment fidelity in a Web-based cognitive behavioral stress management (CBSM) intervention. Rationale/Conceptual Basis/Background: Treatment fidelity pertains to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. Inadequate treatment fidelity during research can lead to implementation of ineffective interventions or failure to implement effective interventions.  Approaches to establishing treatment fidelity in Web-based interventions differ from those used in interventions that are delivered in person. Methods: The CBSM intervention Coping with Cancer Workbook, adapted for Web-based delivery from an in-person intervention, was tested in a randomized controlled trial with 123 breast cancer survivors. Study participants were recruited and self-selected primarily through the Army of Women’s Website (www.armyofwomen.org). The web-based intervention included training in cognitive behavioral therapy techniques, coping-skills, social support, anger management and assertiveness, and a variety of relaxation techniques.  During the 10-week experimental phase, participants randomized to the intervention group (n = 62) completed one chapter each week. The control group participants (n = 61) were on a “wait list” during the 10-week experimental phase, after which they received uncontrolled access to the online workbook.  Besides presenting didactic information in an intuitive, easy to access manner, the workbook provided self-assessments with tailored feedback, interactive activities and problem-solving exercises that encouraged self-reflection, and relaxation exercises.  Strategies for ensuring treatment fidelity were implemented and assessed. The National Institutes of Health (NIH) Behavior Change Consortium (BCC) Treatment Fidelity Guidelines were relevant to establishing treatment fidelity for the Web-based CBSM intervention. Study design, provider training, treatment delivery, receipt of treatment, and enactment of treatment skills were evaluated for treatment fidelity. Results:  Analyses suggest that the design of the Web-based Coping with Cancer Workbook improved receipt of the intervention and allowed participants to improve their coping skills. Since interventionists were not required, potential threats to treatment fidelity related to ensuring proper training and delivery of the intervention by an interventionist were eliminated. However, the potential for participants receiving an inadequate intervention dose posed a threat to treatment fidelity.  It was also a challenge to determine whether participants used the skills in daily life. Implications: Web-based delivery of behavioral interventions is both a strength and a threat to treatment fidelity. Nurse investigators must be cognizant of the elements of treatment fidelity and implement strategies to monitor and improve the reliability and validity of Web-based interventions.  It is hoped that future investigators will build on the approach described in this paper for using the NIH BCC Treatment Fidelity Guidelines to ensure treatment fidelity of Web-based interventions. This research is supported by funding from the National Cancer Institute (2 R44 CA106154-02A1) and the National Institute of Nursing Research (R21NR010725-01).
Keywords:
Web based behavioral intervention; Treatment fidelity
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5526
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleESTABLISHING TREATMENT FIDELITY IN A WEB-BASED BEHAVIORAL INTERVENTION STUDYen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211583-
dc.description.abstractPurpose/Aims:  The purpose of this paper is to describe a methodology for ensuring treatment fidelity in a Web-based cognitive behavioral stress management (CBSM) intervention. Rationale/Conceptual Basis/Background: Treatment fidelity pertains to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. Inadequate treatment fidelity during research can lead to implementation of ineffective interventions or failure to implement effective interventions.  Approaches to establishing treatment fidelity in Web-based interventions differ from those used in interventions that are delivered in person. Methods: The CBSM intervention Coping with Cancer Workbook, adapted for Web-based delivery from an in-person intervention, was tested in a randomized controlled trial with 123 breast cancer survivors. Study participants were recruited and self-selected primarily through the Army of Women’s Website (www.armyofwomen.org). The web-based intervention included training in cognitive behavioral therapy techniques, coping-skills, social support, anger management and assertiveness, and a variety of relaxation techniques.  During the 10-week experimental phase, participants randomized to the intervention group (n = 62) completed one chapter each week. The control group participants (n = 61) were on a “wait list” during the 10-week experimental phase, after which they received uncontrolled access to the online workbook.  Besides presenting didactic information in an intuitive, easy to access manner, the workbook provided self-assessments with tailored feedback, interactive activities and problem-solving exercises that encouraged self-reflection, and relaxation exercises.  Strategies for ensuring treatment fidelity were implemented and assessed. The National Institutes of Health (NIH) Behavior Change Consortium (BCC) Treatment Fidelity Guidelines were relevant to establishing treatment fidelity for the Web-based CBSM intervention. Study design, provider training, treatment delivery, receipt of treatment, and enactment of treatment skills were evaluated for treatment fidelity. Results:  Analyses suggest that the design of the Web-based Coping with Cancer Workbook improved receipt of the intervention and allowed participants to improve their coping skills. Since interventionists were not required, potential threats to treatment fidelity related to ensuring proper training and delivery of the intervention by an interventionist were eliminated. However, the potential for participants receiving an inadequate intervention dose posed a threat to treatment fidelity.  It was also a challenge to determine whether participants used the skills in daily life. Implications: Web-based delivery of behavioral interventions is both a strength and a threat to treatment fidelity. Nurse investigators must be cognizant of the elements of treatment fidelity and implement strategies to monitor and improve the reliability and validity of Web-based interventions.  It is hoped that future investigators will build on the approach described in this paper for using the NIH BCC Treatment Fidelity Guidelines to ensure treatment fidelity of Web-based interventions. This research is supported by funding from the National Cancer Institute (2 R44 CA106154-02A1) and the National Institute of Nursing Research (R21NR010725-01).en_GB
dc.subjectWeb based behavioral interventionen_GB
dc.subjectTreatment fidelityen_GB
dc.date.available2012-02-20T12:03:38Z-
dc.date.issued2012-02-20T12:03:38Z-
dc.date.accessioned2012-02-20T12:03:38Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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