Andréa A G Nes
Lovisenberg Diaconal University College, Norway
Title: Examining fidelity in mHealth behaviour interventions based on acceptance and commitment therapy to support self-management in persons with chronic illness
Biography
Biography: Andréa A G Nes
Abstract
Background: Behavioral interventions combining mobile technology and internet are becoming an alternative for treatment aimed to support self-management in persons with chronic illness. The use of new technology has introduced challenges in monitoring of treatment fidelity, essential to ensure internal and external validity.
Objective: To present and discuss how treatment fidelity of a smartphone delivered intervention can be planned and managed, giving examples from two studies; support of self-management in persons with chronic widespread pain (CWP) and diabetes mellitus type 2 (DMT2). The interventions were based on acceptance and commitment therapy (ACT) with e-diaries and written situational feedback, applying the recommendations from the behavior change consortium (BCC) established by The National Institutes of Health (NIH).
Methods: To investigate the treatment fidelity, the therapists’ adherence to the treatment protocol was analyzed. The written feedback messages were divided in text segments and qualitative thematic analyses were done to examine how ACT and other therapeutic processes were used in the feedback by the therapists. For the therapists’ and participants’ experience analysis, participants answered a self-reported questionnaire and participated in two interviews. The therapists spontaneously reported their experiences to the researcher responsible for the project.
Results: The result of the fidelity studies showed high therapists’ adherence to the treatment protocol. ACT processes were found in the coded text segments of the feedback in addition to communication and motivation strategies. The evaluation of participants’ and therapists’ experience with the intervention was positive.
Conclusions: Based on the level of therapists’ adherence to ACT-principles and participants’ and therapists’ experience with the intervention, the five areas of treatment fidelity was recommended by NIH. BCC were analyzed indicating a high level of treatment fidelity in both studies. These results ensure that treatment fidelity can be appropriately assessed in interventions combining technology and internet.