Implementation Fidelity of Diabetes Self-management Education Programs: a Systematic Review

Abstract

Background: As diabetes requires extensive self-care, self-management education is widely recommended to enhance the effectiveness and reduce the costs of treatment. While a variety of diabetes self-management (DSM) programs are available, the conditions for their effective implementation are not well documented. This paper reviews the literature on implementation fidelity (IF) as a factor influencing the effectiveness of diabetes education. Methods: Medical, psychological and educational research databases were searched to identify published studies on diabetes education describing the implementation process. Studies detailing the intervention adherence/fidelity/integrity were included to assess the way key elements of IF were addressed. Findings: From an initial 418 abstracts, 20 published papers were retained for an in-depth analysis focusing on the components of IF. Intervention content was mainly assessed through observation, whereas intervention dose was more often assessed through self-report measures. Only one study addressed the relationship between IF and intervention effectiveness. Discussion: Despite the importance of IF to achieve program outcomes, IF of DSM programs remains largely under-investigated. The results of this review suggest that reports on DSM education should systematically describe how the program was implemented.