Publications
Case studies from health psychologists. Suhana's case study is on page 47
Intervention fidelity concerns the degree to which interventions are implemented as intended. Fidelity frameworks propose fidelity is a multidimensional concept relevant at intervention designer, provider, and recipient levels; yet the extent to which it is assessed multidimensionally is unclear. Smoking cessation interventions are complex; this increases susceptibility variation in the fidelity with which they are delivered. This review examined the extent to which dimensions from the Behaviour Change Consortium fidelity framework (design, training, delivery, receipt & enactment) were assessed in fidelity assessments of smoking cessation interventions (randomised control trials (RCTs)).
Methods. Five electronic databases were searched. Eligible studies included RCTs of smoking cessation behavioural interventions, published post 2006 after publication of the framework, reporting assessment of fidelity. The data extraction form was structured around the framework, which specifies a number of items regarding assessment and reporting of each dimension. Data extraction included study characteristics, dimensions assessed, data collection & analysis strategies. A score per dimension was calculated, indicating its presence.
Results. 55 studies were reviewed. There was a wide variability in data collection approaches used to assess fidelity. Fidelity of delivery was the most commonly assessed & linked to the intervention outcomes (73% of the studies). Fidelity of enactment scored the highest according to the framework (average of 92.7%) & fidelity of training scored the lowest (average of 37.1%). Only a quarter of studies linked fidelity data to outcomes (27%).
Conclusion. There is wide variability in methodological and analytical approaches. In order to realise the potential of fidelity investigations to increase scientific confidence in the interpretation of observed trial outcomes, studies should include analyses of the association between fidelity data and outcomes.
Aims: To identify the barriers to and enablers of effective insulin self-titration in people with Type 2 diabetes.
Methods: A qualitative semi-structured interview approach was used. Questions were structured according to the Theoretical Domains Framework, which outlines 14 domains that can act as barriers to and enablers of changing behaviour. Interviews were audio-recorded and transcribed verbatim. The data were coded according to the 14 domains, belief statements were created within each domain, and a frequency count of the most reported barriers and enablers was then carried out. Analyses were conducted by two researchers, and discrepancies agreed with a third researcher.
Results: A total of 18 adults with Type 2 diabetes took part in an interview. The majority were of South-Asian ethnicity (n = 8) and were men (n = 12). Their mean age was 61 years old. The mean duration of diabetes was 16 years and time on insulin 9 years. Inter-rater reliability for each of the domains varied (29-100%). The most frequently reported domains were Social Influence and Beliefs about Consequences; the least frequently reported were Optimism and Reinforcement. Interviewees reported receiving support to self-titrate from a range of sources. Self-titrating was perceived to have a range of both positive and negative consequences, as was not titrating.
Conclusions: The findings highlight that those interviewed experienced a range of barriers and enablers when attempting to self-titrate. Improved education and training when initiating insulin treatment among adults with Type 2 diabetes, and throughout their journey on insulin therapy could help identify and address these barriers in order to optimize self-titration.
Background: This study aimed to explore the barriers and enablers to quitting khat from the perspective of users and the barriers and enablers to supporting users to quit from the perspective of healthcare professionals (HCPs).
Methods: The present qualitative study was conducted using semi-structured interviews and the Theoretical Domains Framework (TDF) to collect and analyse data.
Findings: Overall, 10 khat users and 3 professionals were interviewed. Beliefs about the consequences of continued use facilitated user's decisions to quit. Social influences were both a barrier and an enabler. For professionals, the social influence of other colleagues and working together was key in enabling them to support clients. Social/professional role and identity was also an important enabler, as professionals saw supporting users to quit as an integral part of their role. A range of behaviour change techniques was identified as potential ways in which quitting attempts could be more successful, from the perspective of users and professionals.
Conclusion: The study reveals the complexity of khat chewing and quitting from the perspective of khat users, such as the varied influence of family and friends. It also identifies the many barriers and enablers that professionals experience when supporting individuals to quit, such as working with other professionals. There is little evidence for the effectiveness of current services provided for quitting khat or little information outlining how they were developed. Current services would benefit from evaluating the effectiveness of the interventions using established methodology. Recommendations have been provided for practice in the field of substance misuse.
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