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Assessing fidelity of delivery of smoking cessation behavioural support in practice
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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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“Improved coding systems cannot facilitate detection of a BCT if the description omits to mention that it was included in the intervention; Lorencatto et al. 12 found that published descriptions reported, on average, less than half the BCTs that were included in the longer protocol descriptions.”
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Self-citation
Metadata
- 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)
- PMC
- PMC3622616
- 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
- gold
- doi.org
- Licence
- 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 › Public Health, Environmental and Occupational Health › 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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