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Reporting of Treatment Fidelity in Mindfulness-Based Intervention Trials: A Review and New Tool Using NIH Behavior Change Consortium Guidelines
Open accessAbstract
Mindfulness-based interventions (MBIs) are in the fourth decade of adaptation and testing, yet little is known about their level of treatment fidelity. Treatment fidelity is a methodological strategy used to monitor and enhance the reliability and validity of behavioral interventions. The Treatment Fidelity Workgroup of the National Institutes of Health Behavior Change Consortium (BCC) put forth recommendations covering five components of treatment fidelity: design, training, delivery, receipt, and enactment. We conducted a literature review to describe how these five components of treatment fidelity are reported in published main outcomes articles of MBI efficacy trials among adult participants. Our search yielded 202 articles and we identified 25 (12%) described study treatment fidelity. All 25 studies reported on design, n=24 (96%) reported on training, n=23 (92%) reported on delivery, n=23 (92%) reported on receipt, and n=16 (64%) reported on enactment. Eleven (44%) articles analyzed measures of receipt and enactment with a participant outcome. Fourteen (56%) articles reported on all five fidelity components. There was high variation in the way each component was conducted and/or reported, making comparisons across articles difficult. To address the prevailing limitation that the majority of MBI efficacy studies did not detail treatment fidelity, we offer the Treatment Fidelity Tool for MBIs adapted from the BCC guidelines to help researchers monitor and report these methods and measures in a simple and standardized format. By using this tool, researchers have the opportunity to improve the transparency and interpretability of the MBI evidence base.
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“Fidelity to each MBPs protocol was assessed after each session, with an adapted treatment fidelity tool, which is based on Kechter et al. (2019) recommendations for reporting treatment fidelity in MBP trials.”
From Testing Mindfulness Mechanisms of Action on the Stress and Burnout of Social Workers (2024) · cites this paper as Kechter et al., 2019
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“Facilitators assessed whether they had followed each week's session plan using a treatment fidelity tool based on Kechter et al. (2018) MBP treatment fidelity reporting recommendations.”
From Exploring the Potential Mechanisms of Action of the Mindfulness-based Social Work and Self-care Programme. (2022) · cites this paper as Kechter et al., 2018
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Cites
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“The first two—behavioral therapy and then cognitive behavioral therapy—focus on modification of thoughts, feelings, and behaviors whereas MBIs focus on developing metacognitive awareness, acceptance, and a non-reactive stance to those same experiential processes (Crane et al. 2017).”
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BackgroundImplementation fidelity in community‐based interventions
Breitenstein, S. M., Gross, D. A., Garvey, C., Hill, C., Fogg, L., & Resnick, B. M. (2010) · Research in Nursing & Health · doi:10.1002/nur.20373 · Cited by 717 · cited 3×
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“Four (24% of those reporting any aspect of enactment) articles reported collecting both practice logs and FFMQ or MAAS (Bowen et al. 2009; de Vibe et al. 2013; Gross et al. 2010; Eisendrath et al. 2016).”
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“Among studies that included an active control group, all ten (40%) articles described equivalent methods of monitoring the delivery of both groups (Cherkin et al. 2016;Eisendrath et al. 2016;Garland et al. 2016;Garland et al. 2014;Gross et al. 2010; Hoge et al. 2013; Hughes et al. 2013; Shallcross et al. 2015; William…”
BackgroundMindfulness-Based Eating Awareness Training (MB-EAT) for Binge Eating: A Randomized Clinical Trial
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“Three (12%) of all articles reported more than one of the above methods (Palta et al. 2012; Shallcross et al. 2015; Williams et al. 2014).”
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“2012), another calculated number of days and hours per week (Barnhofer et al. 2009), and another calculated a practice score (0–20) based on 4 questions pertaining to the past 4-weeks (de Vibe et al.”
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“Given that behavioral intervention trial findings have limited interpretation value if they lack treatment fidelity (Forgatch et al. 2005), it is important researchers report methods and measures of treatment fidelity in main outcome articles to inform readers if the intervention was implemented as designed and then a…”
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“Furthermore, we only included RCTs with the intent to focus on studies with the highest standard for internal validity; consequently, we omit quasiexperimental studies that may have reported on treatment fidelity.”
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“…paucity of treatment fidelity reports in published literature remains a weakness across these behavioral interventions, which limits our ability to conclude an intervention is efficacious due to the intended program elements (Breitenstein et al. 2010; Gould et al. 2016; Lichstein et al. 1994).”
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“One article reported a post-hoc questionnaire on mindfulness practice across three study periods (Bondolfi et al. 2010).”
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“2005), it is important researchers report methods and measures of treatment fidelity in main outcome articles to inform readers if the intervention was implemented as designed and then accurately tested in the experimental trial (Resnick et al. 2005).”
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Moynihan, J. A., Chapman, B. P., Klorman, R., Krasner, M. S., Duberstein, P. R., Brown, K. W., & Talbot, N. L. (2013) · Neuropsychobiology · doi:10.1159/000350949 · Cited by 210
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“Among studies that included an active control group, all ten (40%) articles described equivalent methods of monitoring the delivery of both groups (Cherkin et al. 2016;Eisendrath et al. 2016;Garland et al. 2016;Garland et al. 2014;Gross et al. 2010; Hoge et al. 2013; Hughes et al. 2013; Shallcross et al. 2015; William…”
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“, determining the program is not effective due to poor treatment fidelity or implementation failure), which incurs an economic and scientific burden (Gould et al. 2016; Breitenstein et al. 2010; Borrelli 2011).”
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Self-citationRandomized controlled trial of mindfulness-based stress reduction for prehypertension
Hughes, J. W., Fresco, D. M., Myerscough, R., H. M. van Dulmen, M., Carlson, L. E., & Josephson, R. (2013) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3182a3e4e5 · Cited by 142 · cited 1×
“Among studies that included an active control group, all ten (40%) articles described equivalent methods of monitoring the delivery of both groups (Cherkin et al. 2016;Eisendrath et al. 2016;Garland et al. 2016;Garland et al. 2014;Gross et al. 2010; Hoge et al. 2013; Hughes et al. 2013; Shallcross et al. 2015; William…”
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“Two articles did not report on any subcomponent of delivery (Carmody et al. 2011; Palta et al. 2012).”
BackgroundResultInfluentialGross, C. R., Kreitzer, M. J., Thomas, W., Reilly-Spong, M., Cramer–Bornemann, M., Nyman, J. A., Frazier, P. A., & Ibrahim, H. N. (2010) · PubMed · Cited by 141
The Utility of Home-Practice in Mindfulness-Based Group Interventions: A Systematic Review
Lloyd, A., White, R. G., Eames, C., & Crane, R. S. (2017) · Mindfulness · doi:10.1007/s12671-017-0813-z · Cited by 126 · cited 1×
“However, we believe the quality of one’s practice is limited to their comprehension and competence, such that measuring the quantity of home practice does not gauge the degree to which participants properly comprehend and adhere to the principles of mindfulness practice (Lloyd et al. 2017).”
BackgroundLengacher, C. A., Shelton, M. M., Reich, R. R., Barta, M. K., Johnson-Mallard, V., Moscoso, M. S., Paterson, C., Ramesar, S., Budhrani, P., Carranza, I., et al. (2014) · Journal of Behavioral Medicine · doi:10.1007/s10865-012-9473-6 · Cited by 117 · cited 1×
“One reported moderation analyses using median split of enactment measures (Lengacher et al. 2014; Shallcross et al. 2015).”
MethodGeschwind, N., Peeters, F., Huibers, M., van Os, J., & Wichers, M. (2012) · British Journal of Psychiatry · doi:10.1192/bjp.bp.111.104851 · Cited by 89 · cited 2×
“One reported t test analyses using enactment measures (Geschwind et al. 2012; Moynihan et al. 2013).”
BackgroundMethodShallcross, A. J., Gross, J. J., Visvanathan, P. D., Kumar, N., Palfrey, A., Ford, B. Q., Dimidjian, S., Shirk, S., Holm-Denoma, J., Goode, K. M., et al. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000050 · Cited by 81 · cited 5×
“Two reported moderation with interaction term in regression analyses using both receipt and enactment measures (de Vibe et al. 2013; Shallcross et al. 2015).”
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“Adequately monitoring and reporting treatment fidelity when publishing efficacy outcomes allows for assessment of whether observed treatment effects in an empirical trial are attributable to the intervention delivered (Carroll et al. 2007; Leeuw et al. 2009).”
BackgroundJaKa, M. M., Haapala, J. L., Trapl, E., Kunin‐Batson, A., Olson‐Bullis, B. A., Heerman, W. J., Berge, J. M., Moore, S. M., Matheson, D., & Sherwood, N. E. (2016) · Obesity Reviews · doi:10.1111/obr.12464 · Cited by 54 · cited 2×
“2016) and pediatric obesity intervention trials (JaKa et al. 2016).”
ResultMindfulness and Substance Use Intervention
Black, D. S. (2012) · Substance Use & Misuse · doi:10.3109/10826084.2011.635461 · Cited by 50
Self-citationGarland, E. L., Thomas, E. A., & Howard, M. O. (2014) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2014.03.006 · Cited by 40 · cited 1×
“Among studies that included an active control group, all ten (40%) articles described equivalent methods of monitoring the delivery of both groups (Cherkin et al. 2016; Eisendrath et al. 2016; Garland et al. 2016; Garland et al. 2014; Gross et al. 2010; Hoge et al. 2013; Hughes et al. 2013; Shallcross et al. 2015; Wil…”
BackgroundJull, A., & Aye, P. S. (2014) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2014.11.008 · Cited by 34 · cited 9×
“Furthermore, we only included RCTs with the intent to focus on studies with the highest standard for internal validity; consequently, we omit quasiexperimental studies that may have reported on treatment fidelity.”
MethodInfluentialAmaro, H. D. L. A., & Black, D. S. (2017) · Contemporary Clinical Trials · doi:10.1016/j.cct.2017.09.004 · Cited by 32 · cited 2×
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript residential treatment for substance use disorders (Amaro and Black 2017).”
BackgroundMethodSelf-citationZgierska, A. E., Shapiro, J., Burzinski, C. A., Lerner, F., & Goodman-Strenski, V. (2017) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2017/9716586 · Cited by 15
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Self-citation
Metadata
- Authors
- Kechter, A., Amaro, H., & Black, D. S.
- Affiliations
- University of Southern California (US)
- Corresponding author
- Kechter, Afton
- Venue
- Mindfulness
- Published
- 2018-06-22
- Volume
- 10
- Issue
- 2
- Pages
- 215-233
- ISSN
- 1868-8527 (ISSN-L)
- 1868-8535
- PMC
- PMC6402837
- OpenAlex
- W2809044941
- Cited by
- 102
- References
- 56
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 8 · 2023: 7 · 2022: 11 · 2021: 10 · 2020: 51 · 2019: 1
- FWCI
- 18.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Mindfulness (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (5T32CA009492-33)
- National Institute on Drug Abuse (5R01DA038648)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Keywords
- intervention fidelity, mindfulness-based interventions, intervention delivery, therapist training, treatment receipt, reporting guidelines
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