Cited by 107Smoking Behavior and CessationHealth Policy Implementation ScienceBehavioral Health and Interventions

Assessing fidelity of delivery of smoking cessation behavioural support in practice

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Lorencatto, Fabiana, West, Robert, Christopherson, Charlotte, Michie, Susan·2013·Implementation Science

Abstract

BACKGROUND: Effectiveness of evidence-based behaviour change interventions is likely to be undermined by failure to deliver interventions as planned. Behavioural support for smoking cessation can be a highly cost-effective, life-saving intervention. However, in practice, outcomes are highly variable. Part of this may be due to variability in fidelity of intervention implementation. To date, there have been no published studies on this. The present study aimed to: evaluate a method for assessing fidelity of behavioural support; assess fidelity of delivery in two English Stop-Smoking Services; and compare the extent of fidelity according to session types, duration, individual practitioners, and component behaviour change techniques (BCTs). METHODS: Treatment manuals and transcripts of 34 audio-recorded behavioural support sessions were obtained from two Stop-Smoking Services and coded into component BCTs using a taxonomy of 43 BCTs. Inter-rater reliability was assessed using percentage agreement. Fidelity was assessed by examining the proportion of BCTs specified in the manuals that were delivered in individual sessions. This was assessed by session type (i.e., pre-quit, quit, post-quit), duration, individual practitioner, and BCT. RESULTS: Inter-coder reliability was high (87.1%). On average, 66% of manual-specified BCTs were delivered per session (SD 15.3, range: 35% to 90%). In Service 1, average fidelity was highest for post-quit sessions (69%) and lowest for pre-quit (58%). In Service 2, fidelity was highest for quit-day (81%) and lowest for post-quit sessions (56%). Session duration was not significantly correlated with fidelity. Individual practitioner fidelity ranged from 55% to 78%. Individual manual-specified BCTs were delivered on average 63% of the time (SD 28.5, range: 0 to 100%). CONCLUSIONS: The extent to which smoking cessation behavioural support is delivered as specified in treatment manuals can be reliably assessed using transcripts of audiotaped sessions. This allows the investigation of the implementation of evidence-based practice in relation to smoking cessation, a first step in designing interventions to improve it. There are grounds for believing that fidelity in the English Stop-Smoking Services may be low and that routine monitoring is warranted.

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  1. Michie S Churchill S West R Identifying evidence-based competences required to deliver behavioural support for smoking cessation Annals of Behavioural Medicine 2011 41 49 70 20936389

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Authors
Lorencatto, F., West, R., Christopherson, C., & Michie, S.
Affiliations
  • University College London (GB)
  • Cancer Research UK (GB)
Corresponding author
Lorencatto, Fabiana
Venue
Implementation Science
Published
2013-04-04
Volume
8
Issue
1
Pages
40-40
ISSN
1748-5908 (ISSN-L)
OpenAlex
W2118846366
Cited by
107
References
47
Citations by year
2026: 2 · 2025: 5 · 2024: 5 · 2023: 12 · 2022: 6 · 2021: 16 · 2020: 7 · 2019: 10 · 2018: 13 · 2017: 6 · 2016: 3 · 2015: 13 · 2014: 6 · 2013: 2
FWCI
5.57
Type
journal article
Language
en
Open access
Locations
  • Implementation Science (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • City Research Online (City University London) (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
Cancer Research UK (14135)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
smoking cessation, behavioral support, intervention fidelity, behaviour change techniques, smoking cessation services, treatment manual, session transcripts, evidence-based practice implementation
MeSH terms
Behavior Therapy, Classification, Delivery of Health Care, Humans, Motivation, Professional Practice, Quality of Health Care, Observer Variation, Smoking Cessation, Evidence-Based Medicine, General Practice

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