Delivery fidelity of the REACT (REtirement in ACTion) physical activity and behaviour maintenance

Cross et al. BMC Public Health (2022) 22:1112

https://doi.org/10.1186/s12889-022-13496-z

RESEARCH

Delivery fdelity of the REACT (REtirement

in ACTion) physical activity and behaviour

maintenance intervention for community

dwelling older people with mobility limitations

Rosina Cross1*, Colin J. Greaves2

, Janet Withall2

, W. Jack. Rejeski3 and Afroditi Stathi2

Abstract

Background: Fidelity assessment of behaviour change interventions is vital to understanding trial outcomes. This

study assesses the delivery fdelity of behaviour change techniques used in the Retirement in ACTion (REACT) ran￾domised controlled trial. REACT is a community-based physical activity (PA) and behaviour maintenance intervention

to prevent decline of physical functioning in older adults (≥65 years) at high risk of mobility-related disability in the

UK.

Methods: The delivery fdelity of intervention behaviour change techniques and delivery processes were assessed

using multi-observer coding of purposively sampled in-vivo audio recordings (n=25) of health behaviour mainte￾nance sessions over 12-months. Delivery fdelity was scored using a modifed Dreyfus scale (scores 0–5) to assess

competence and completeness of delivery for each technique and delivery process. “Competent delivery” was

defned as a score of 3 points or more for each item. Examples of competent intervention delivery were identifed to

inform recommendations for future programme delivery and training.

Results: The mean intervention fdelity score was 2.5 (SD 0.45) with delivery fdelity varying between techniques/

processes and intervention groups. Person-centred delivery, Facilitating Enjoyment and Promoting Autonomy were

delivered competently (scoring 3.0 or more). There was scope for improvement (score 2.0—2.9) in Monitoring Pro￾gress (Acknowledging and Reviewing), Self-Monitoring, Monitoring Progress (Eliciting Benefts of Physical Activity),

Goal Setting and Action Planning, Modelling, Supporting Self-Efcacy for Physical Activity and Supporting Related￾ness. Managing Setbacks and Problem Solving was delivered with low fdelity. Numerous examples of both good and

sub-optimal practice were identifed.

Conclusions: This study highlights successes and improvements needed to enhance delivery fdelity in future imple￾mentation of the behavioural maintenance programme of the REACT intervention. Future training of REACT session

leaders and assessment of delivery fdelity needs to focus on the delivery of Goal setting and Action Planning, Model￾ling, Supporting Relatedness, Supporting Self-Efcacy for Physical Activity, and Managing Setbacks/ Problem Solving.

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Open Access

*Correspondence: [email protected]

1

Department for Health, University of Bath, Claverton Down, Bath BA2 7AY,

UK

Full list of author information is available at the end of the article