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The development of a comprehensive fidelity monitoring plan for a web-based psycho-educational intervention: The WRITE symptoms study

Year: 2011
Type: article
Abstract: The purpose of this study was to develop and evaluate a comprehensive intervention fidelity monitoring plan for a web-based symptom management intervention for women with recurrent ovarian cancer, the nurse-delivered WRITE Symptoms intervention. Because the intervention was designed to be flexible and dynamic to meet the individual needs of each participant, a comprehensive monitoring plan was necessary to ensure internal validity of the trial evaluating the efficacy of WRITE Symptoms. The first phase of this study was the development of a fidelity instrument. The instrument development began with a review of fidelity literature and the underlying intervention theory to guide item selection and scaling. An iterative process was used to identify, develop, and refine the items for the instrument and the interventionist manual. Several rounds of expert review and item revision resulted in a preliminary instrument to be used in the initial evaluation process. A sample of five mock intervention sessions was used to evaluate inter-rater reliability for the instrument. Modifications were made to items with low reliability. The revised instrument contained 13 subscales with 54 items. The revised instrument was then evaluated using twenty completed interventions from the WRITE Symptoms RCT. Analyses included inter-rater reliability and two week intra-rater reliability. The instrument demonstrated acceptable psychometric properties. Inter-rater reliability based on weighted Kappa range from 0.47 to 1.00 and percentage of agreement (POA) range from 85 to 100 for each individual item. Intra-rater reliability was also good with weighted Kappa of 0.48 to 1.00 and POA of 85 to 100 for each individual item. An intervention fidelity-manual was developed to address two topics: (1) how to use the instrument to monitor fidelity of the nurse-delivered WRITE Symptoms intervention and (2) how to train raters to use the instrument. Finally, an analytic plan was proposed for understanding the influence of fidelity on intervention outcomes. Further research should address two questions: (1) is intervention fidelity a predictor of intervention outcomes and (2) what is the active ingredient of the nurse-delivered WRITE Symptoms intervention?
Language: English
Open Access status: green
OpenAlex ID: W59422239
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