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Evaluation and facilitation of intervention fidelity in community exercise programs through an adaptation of the TIDier framework


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Bird, M-L ORCID: 0000-0001-9642-7196, Mortenson, WB and Eng, JJ 2020 , 'Evaluation and facilitation of intervention fidelity in community exercise programs through an adaptation of the TIDier framework' , BMC Health Services Research, vol. 68 , pp. 1-7 , doi: 10.1186/s12913-020-4919-y.

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Background: Despite high quality evidence supporting multiple physical and cognitive benefits of communitybased exercise for people after stroke, there is little understanding on how to facilitate uptake of these researchfindings to real-world programs. A common barrier is a lack of standardised training for community fitnessinstructors, which hampers the ability to train more instructors to deliver the program as it was designed. Scalingup program delivery, while maintaining program fidelity, is complex. The objective of this research is to explorenovel use of the Template for Intervention Description and Replication (TIDier) framework to evaluate and supportimplementation fidelity of a community exercise program.Methods: We embedded intervention fidelity evaluation into an inaugural training program for fitness instructorswho were to deliver the Fitness and Mobility Exercise Program for stroke, which has established efficacy. Thetraining program consisted of a face-to-face workshop followed by 3 worksite ‘audit and feedback coaching cycles’provided over 3 iterations of the 12-week program offered over 1 year. A modified TIDIER checklist (with 2additional criteria) was used within the training workshop to clarify the key ‘active ingredients’ that were requiredfor program fidelity, and secondly as a basis for the audit and feedback process enabling the quantitativemeasurement of fidelity. Data were collected from audits of observed classes and from a survey provided by fitnessinstructors who implemented the program.Results: We demonstrated the feasibility of the TIDier checklist to capture 14 essential items for implementationevaluation of a complex exercise intervention for people with chronic health conditions over 3 iterations of theprogram. Based on the audit tool, program fidelity was high and improved over time. Three content areas forworkplace coaching (intensity monitoring, space, and educational tips) were identified from the audit tool and wereaddressed.Conclusion: Training of staff to deliver exercises to high need populations utilising workshops and workplacecoaching that used the TIDier framework for training, onsite audit and feedback resulted in a high level of fidelityto the program principles. A novel checklist based on the TIDier framework was useful for embeddingimplementation fidelity in complex community-based interventions.

Item Type: Article
Authors/Creators:Bird, M-L and Mortenson, WB and Eng, JJ
Keywords: implementation, fidelity, framework, adaptation, evaluation, program, scale-up
Journal or Publication Title: BMC Health Services Research
Publisher: Biomed Central Ltd
ISSN: 1472-6963
DOI / ID Number: 10.1186/s12913-020-4919-y
Copyright Information:

Copyright The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (, which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver( applies to the data made available in this article, unless otherwise stated.

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