Assessing Fidelity of a Community-Based Opioid Overdose Prevention Program: Modification of the Fidelity Checklist

When conducting research measuring behavioral change, it is important to assess the true relationship between the independent and dependent variable, while identifying and minimizing the modifying and extraneous effects associated with intervention delivery (Resnick et al., 2005). Treatment fidelity is the degree in which interventions are delivered as outlined by the program developers (Bellg et al., 2004; Carroll et al., 2007). While the use of fidelity monitoring and fidelity checklists have been documented in behavioral intervention research (Leeuw, Goossens, de Vet, & Vlaeyen, 2009), there have been no publications documenting a systematic process for modifying fidelity checklists. The purpose of this article is to describe the systematic adaptation of the Fidelity Checklist (FC)-a valid and reliable tool for measuring treatment fidelity-for fidelity assessment of a group-based community opioid overdose prevention program (OOPP). Specifically, we will:^ Define treatment fidelity and describe the need for measuring treatment fidelity in behavioral change interventions;^ Provide an overview of the FC (Breitenstein et al., 2010), including a description of the tool, a discussion of its purpose, and a report of initial findings from early testing of the tool;^ Describe the modification of the FC for use in a groupbased community OOPP.Fidelity measurement may assist with the translation of interventions into clinical practice. The process described in this article will assist researchers with the measurement of fidelity across different interventional settings.BackgroundTreatment fidelity is an important source of variation that affects both the utility of interventions and the credibility of findings (Carroll et al., 2007; Kubiak, Fedock, Tillander, Kim, & Bybee, 2014). Fidelity is determined by three factors: (a) clinicians' adherence to the manual or protocol, (b) clinicians' competency in skills supporting the intervention, and (c) the participants' responsiveness during the intervention (Breitenstein et al., 2010; Carroll et al., 2007). Researchers have used various terms to describe treatment fidelity, including but not limited to intervention fidelity, implementation fidelity, and integrity fidelity, all with the purpose to describe the core elements of the intervention required to ensure replication. For the purposes of this article, the term treatment fidelity will be used and the processes associated with ensuring the integrity of treatment delivery will be discussed.Researchers have suggested differing and similar components of treatment fidelity. The National Institutes of Health Behavioral Change Consortium (BCC) described five components of treatment fidelity: design, training, delivery, receipt, and enactment (Bellg et al., 2004). Similarly, Gearing et al. (2011) discussed the "major ingredients" of fidelity as design, training, delivery, and receipt, and provide definitions for each of the elements. The focus of the present work is the fidelity component of delivery and is defined as the processes to monitor and improve the delivery of the intervention so that it is delivered as intended by the developers.The ability of the interventionist to skillfully deliver the treatment and engage participants may impact outcomes (knowledge or other measured behavior change) associated with the intervention. As such, both adherence and competence assessments are necessary to determine fidelity (Santacroce, Maccarelli, & Grey, 2004), and can be measured using subscales of the FC (Breitenstein et al., 2010).The Fidelity ChecklistThe FC was developed to measure group leader implementation of the Chicago Parent Program (CPP; doubleblind review). The CPP is a 12-session, group-based behavioral parenting program delivered in community settings. The FC was established to assess group leaders' maintenance of the weekly CPP protocol (adherence) and their group facilitation and process skills (competence). …