Goal-setting in DAFNE: content and fidelity of the goal-setting component in a diabetes educational-programme

Abstract

BACKGROUND Self-management educational-programmes such as ‘Dose Adjustment For Normal Eating (DAFNE)’ have become part of routine diabetes-care. Unfortunately, the long-term effects of such programmes are often limited. To address long-term behaviour-change, a core component of DAFNE is goal-setting. However, little is known about how this component is delivered in practice. Face-to-face interventions are often not delivered as specified in the manual. Furthermore, without knowledge of fidelity (the extent to which interventions are implemented as intended), establishing intervention effects is challenging. Therefore, we aimed to explore the content and the fidelity of delivery of the goal-setting component of DAFNE. METHOD: Two researchers coded the goal-setting sessions of the DAFNE manual independently, using the behaviour change technique (BCT) taxonomy-v1. Inter-rater reliability was calculated using Cohen’s kappa. Fidelity was assessed by observing and audio-recording a set number of DAFNE goal-setting sessions. The number of BCTs identified in the manual was compared with those delivered in practice. Fidelity was assessed per session, educator and BCTs. FINDINGS: Thirteen BCTs were identified within the manual (k=0.77). ‘Goals and Planning’ BCTs were most frequently implemented. Results show that on average, only half of the BCTs specified in the manual were delivered per session, with fidelity varying significantly by educator. DISCUSSION: This study shows that content of educational-programmes can be reliably coded in terms of BCTs. Overall; fidelity-levels were quite low, and varied greatly between educators. These findings highlight the importance of routine procedures for monitoring delivery of educational-programmes, and suggest that continuous support for educators is needed.