A Method for Assessing Fidelity of Delivery of Telephone Behavioral Support for Smoking Cessation
A Method for Assessing Fidelity of Delivery of Telephone Behavioral Support for Smoking Cessation
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DOI：
10.1037/a0035149
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发表时间：
2014-06-01
影响因子：
5.9
通讯作者：
Michie, Susan
中科院分区：
文献类型：
--
作者：
Lorencatto, Fabiana;West, Robert;Michie, Susan
目的：通过不同的方式提供戒烟的行为支持，通常由治疗手册指导。最近开发的评估交付保真度的方法表明，面对面的行为支持往往没有提供服务治疗手册中规定的。本研究旨在将此方法扩展到电话传递行为支持的保真度评估。方法：从英国国家戒烟热线服务获得了75个音频记录的行为支持会议的治疗手册和成绩单，并使用45个戒烟行为改变技术（BCT）的分类编码成组件。使用百分比一致性评估评估者间可靠性。通过比较手册中确定的BCT数量与4名咨询师在电话会议中提供的BCT数量来评估忠诚度。根据会话类型，持续时间，顾问和BCT评估忠诚度。自我报告和实际BCT使用之间的差异进行了检查。结果：平均编码信度较高（81%）。平均而言，41.8%的手动指定的BCT交付每个会话（SD = 16.2），与顾问的保真度从32%到49%不等。戒烟前的忠诚度最高（46%），对于BCT“提供额外支持的选择”（95%）。忠诚度最低的是辞职日会议（35%）和BCT“设置分级任务”（0%）。会话持续时间与保真度呈正相关（r = 0.585; p <0.01）。使用的BCT明显少于报告使用的BCT，t（15）=-5.52，p < .001。结论：电话传递的行为支持的内容可以可靠地编码的BCT。这可用于评估对治疗手册的忠实度，进而确定培训需求。观察到的低保真度强调需要建立常规程序来监测行为支持的提供。
Objectives: Behavioral support for smoking cessation is delivered through different modalities, often guided by treatment manuals. Recently developed methods for assessing fidelity of delivery have shown that face-to-face behavioral support is often not delivered as specified in the service treatment manual. This study aimed to extend this method to evaluate fidelity of telephone-delivered behavioral support. Method: A treatment manual and transcripts of 75 audio-recorded behavioral support sessions were obtained from the United Kingdom's national Quitline service and coded into component behavior change techniques (BCTs) using a taxonomy of 45 smoking cessation BCTs. Interrater reliability was assessed using percentage agreement. Fidelity was assessed by comparing the number of BCTs identified in the manual with those delivered in telephone sessions by 4 counselors. Fidelity was assessed according to session type, duration, counselor, and BCT. Differences between self-reported and actual BCT use were examined. Results: Average coding reliability was high (81%). On average, 41.8% of manual-specified BCTs were delivered per session (SD = 16.2), with fidelity varying by counselor from 32% to 49%. Fidelity was highest in pre-quit sessions (46%) and for BCT "give options for additional support" (95%). Fidelity was lowest for quit-day sessions (35%) and BCT "set graded tasks" (0%). Session duration was positively correlated with fidelity (r = .585; p < .01). Significantly fewer BCTs were used than were reported as being used, t(15) = -5.52, p < .001. Conclusions: The content of telephone-delivered behavioral support can be reliably coded in terms of BCTs. This can be used to assess fidelity to treatment manuals and to in turn identify training needs. The observed low fidelity underlines the need to establish routine procedures for monitoring delivery of behavioral support.