high fidelity: translating the evidence- base into real world settings dr jo holliday, research...
TRANSCRIPT
High Fidelity: Translating the evidence-base into real world settings
Dr Jo Holliday, Research Fellow, Cardiff University
Sally Good, Chief Operating Officer, DECIPHer Impact
Potential conflict of interest: Sally Good is the Chief Operating Officer at DECIPHer Impact Ltd, a not-for-profit company wholly owned by the Universities of Bristol and Cardiff set up to licence and support the implementation of effective health promotion interventions.
Background
Health promotion interventions inherently complex
Background
Health promotion interventions inherently complex
Presents challenges for standardization of delivery evaluation
Pragmatic trials incorporating process evaluation can provide insight into where variation occurs why it occurs and implications of this for wider implementation
Aims of study Discuss issues of fidelity of intervention delivery
encountered within A Stop Smoking in Schools Trial (ASSIST)
Describe the systems established to ensure translation of positive trial findings into real-world settings.
The ASSIST Programme
A school-based, peer-led smoking prevention programme Encourages new norms of smoking behaviour by training
influential Year 8 students to work as ‘peer supporters’ Peer supporters identified as influential by peer group Peer supporters trained during school time but off school site Peer supporters have informal conversations with other
students Support sessions held in school
Evaluation of the ASSIST Programme Evaluated in a pragmatic RCT with integral process evaluation Involved 10,720 students from 59 schools at baseline
Demonstrated a 22 % reduction in the odds of being a regular smoker in intervention schools compared with control schools (Odds ratio 0.78 CI: 0.64-0.96) using follow- up data collected at three time points over two years
MethodsStage Source Method and numberPeer nomination Researchers and sessional staff
involved in administration of peer nomination questionnaire in 30 intervention schools
Self-complete questionnaires (n= 319)
Peer supporter recruitment, training and follow-up sessions
Two researchers in four schools selected for in-depth process evaluation
Trainers who conducted the recruitment meeting, training and follow-up sessions in 30 intervention schools
Non-participant observationRecruitment (n= 3)Training (n= 4)Follow-up session 1 (n= 4)Follow-up session 2 (n= 3)Follow-up session 3 (n= 4)Follow-up session 4 (n= 3)Self-complete questionnaires (n= 583)Post-intervention semi-structured interviews (n= 11)
Post-intervention School staff in 30 intervention schools who were involved with the intervention
Self-complete questionnaires (n= 24)
ResultsVariations observed in terms of: Peer nomination and recruitment Venues Length of sessions Intervention timetable
Trainer to student ratios School staff involvement Training approach
Early implementation of ASSIST Learning from trial incorporated into detailed documentation
‘Training the Trainers’ guide ASSIST programme manual
Monitoring process of early roll out enabled refinement of programme Wales A London Borough A Primary Care Trust in the
South West
Quality Assurance Scores
10
What we have done to enable ASSIST to be implemented
Not-for-profit company - DECIPHer Impact formed in March 2010 Wholly owned by Cardiff University and the University of
Bristol Five board directors (two from each University and an
independent Chair) Chief Operating Officer and new Chief Executive Officer Offices near Bristol
What we have done to enable ASSIST to be implemented
Maintaining fidelity through DECIPHer Impact Ltd
Provision of training to ensure a consistently high standard Provision of a comprehensive programme Manual and regular
updates to good quality materials Support and monitoring of implementation A comprehensive Quality Assurance Framework including:
observation of delivery student feedback school feedback self-assessment
Evidence-based but not prescriptive
Recognition that every customer is different Provision of a framework and guidance to work within
based on our experience of implementing the programme Flexibility is built in and includes:
Traffic light system Suggestions to extend or shorten activities Examples of different ways to achieve objectives
Broad parameters to encompass different group sizes and backgrounds
Ongoing Customer Support through DECIPHer Impact Ltd
Academic guidance available to Company via Board of Directors
Working group provides customers with a direct conduit for feedback
Helpdesk ensures that customers can access support quickly and easily
Teleconferencing provides opportunities throughout the year for sharing best practice
Regular seminars and an annual conference enable sharing of best practice
Using ASSIST Sold under licence for 3 year periods Population based model Banded licence fees based on the number of 10-14 year olds
in a geographical area Option for separate areas to cluster together to benefit from
economies of scale An indication of costs is £42 per student, including the licence
fee, based on 6,000 students taking part in the programme over 3 years
UK rollout to date Over 20,000 young people participated in 2011-2012 Our 3 early adopters have continued to use ASSIST for
over 5 years 1 region of 13 Local Authorities 12 individual Local Authorities 2 Channel Islands 1 country
Contact and Acknowledgements
Jo Holliday, Cardiff University: [email protected]
Sally Good, DECIPHer Impact: [email protected]
ASSIST: Prof R Campbell, Prof L Moore, Dr J Holliday, Dr S Audrey
DECIPHer Impact: Directors: Prof R Campbell, Prof L Moore; Dr G Pierce-Jones,Dr D Sheader, Dr M Hughes, CEO: M Day, COO: S Good
A Stop Smoking in Schools Trial was made possible by funding from the Medical Research Council (grant number G9900538).
The writing of this paper was supported by DECIPHer, a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (RES-590-28-0005), Medical Research Council, the Welsh Assembly Government and the Wellcome Trust (WT087640MA), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.