The assessment of intervention fidelity for smoking cessation behavioural support interventions: a systematic review

Abstract

Background: Intervention fidelity is a multidimensional concept. This review examined the extent to which five dimensions of fidelity proposed by the National Institute of Health Behaviour Change Consortium Fidelity Framework (Design; Training; Delivery; Receipt; Enactment) are assessed in smoking cessation behavioural support interventions. Methods: Electronic database searches using terms related to fidelity, smoking cessation and behavioural interventions identified 17 eligible studies. Data was extracted on study characteristics, fidelity definitions, dimensions assessed, data collection/analysis strategies (e.g. frequency of assessments; coding frameworks; reliability; association with outcomes). Findings: Only five studies assessed more than one fidelity dimension. Delivery was most frequently assessed (94%); Design and Enactment least frequently (6%). Fidelity was defined using variable terminology, typically assessed once, during the intervention, in a sub-sample, by audio-recording intervention sessions and rating fidelity using validated adherence checklists. 50% of studies assessed inter-rater reliability, and only two examined associations between fidelity and outcomes. Discussion: Fidelity is not comprehensively assessed for behavioural support interventions. Standard terminology and methods for assessing fidelity are lacking, highlighting recommendations for improving fidelity evaluations and reporting practices.