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Abstract
Objective To evaluate the fidelity of delivery of a nurse-led intervention to enhance physical activity in patients at risk for cardiovascular diseases, the Activate intervention, by assessing: (1) self-reported fidelity of delivery; (2) observed fidelity of delivery; (3) quality of delivery of the Activate intervention and (4) nurses’ beliefs about their capability, motivation, confidence and effectiveness towards delivering the Activate intervention, including behavioural change techniques.
Design An observational study.
Setting General practices in the Netherlands.
Participants Primary care nurses (n=20) from 16 general practices.
Primary and secondary outcome measures Nurses’ self-reported fidelity was evaluated using checklists (n=282), and the observed fidelity and quality of delivery were examined using audiorecordings of consultations of the delivery of the Activate intervention (n=42). Nurses’ beliefs towards delivering the intervention were assessed using questionnaires (n=72).
Results The self-reported fidelity was 88.1% and observed fidelity was 85.4%, representing high fidelity. The observed fidelity of applied behavioural change techniques was moderate (75.0%). The observed quality of delivery was sufficient and varied among nurses (mean 2.9; SD 4.4; range 0–4). Nurses’ beliefs about their capability, motivation, confidence and effectiveness towards delivering the intervention increased over time.
Conclusions Nurses delivered most intervention components as intended with sufficient quality. Nurses believed they were capable, motivated and confident to deliver the intervention. They believed the intervention was effective to increase patients’ physical activity level. Despite the high fidelity and moderate fidelity of applied behavioural change techniques, the varying quality of delivery within and across nurses might have diluted the effectiveness of the Activate intervention.
Trial registration number NCT02725203.
- primary care
- preventive medicine
- social medicine
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Footnotes
Contributors Conceptualisation and design: HW, CDS, JCAT and MJS. Data collection and management: HW. Data analyses: HW and MHZ. Manuscript development and revisions: all authors. All authors read and approved the final manuscript.
Funding This study was funded by the Dutch Ministry of Health, Welfare and Sports, ZonMw grant number 520001002.
Disclaimer The funder had no role in the design, collection, analysis, and interpretation of data, in the writing of the manuscript, and in the decision to submit the manuscript for publication.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study is nested within the Activate trial, which was approved by the Medical Ethics Research Committee of the University Medical Center Utrecht with protocol ID NL54286.041.15. Data were encoded and analysed anonymously.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.
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