Overview Definitions in addition to Distinctions Dimensions Intervention Fidelity What to Measure Implications
Allmendinger, Glen, Founder and President has reference to this Academic Journal, PHwiki organized this Journal Assessing Intervention Fidelity in RCTs: Concepts in addition to Methods Panelists: David S. Cordray, PhD Chris Hulleman, PhD Joy Lesnick, PhD V in addition to erbilt University Presentation as long as the IES Research Conference Washington, DC June 12, 2008 Overview Session planned as an integrated set of presentations Well begin with: Definitions in addition to distinctions; Conceptual foundation as long as assessing fidelity in RCTs, a special case. Two examples of assessing implementation fidelity: Chris Hulleman will illustrate an assessment as long as an intervention with a single core component Joy Lesnick illustrates additional consideration when fidelity assessment is applied to intervention models with multiple program components. Issues as long as the future Questions in addition to discussion Definitions in addition to Distinctions
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Dimensions Intervention Fidelity Little consensus on what is meant by the term intervention fidelity. But Dane & Schneider (1998) identify 5 aspects: Adherence/compliance program components are delivered/used/received, as prescribed; Exposure amount of program content delivered/received by participants; Quality of the delivery theory-based ideal in terms of processes in addition to content; Participant responsiveness engagement of the participants; in addition to Program differentiation unique features of the intervention are distinguishable from other programs (including the counterfactual) Distinguishing Implementation Assessment from Implementation Fidelity Assessment Two models of intervention implementation, based on: A purely descriptive model Answering the question What transpired as the intervention was put in place (implemented). An a priori intervention model, with explicit expectations about implementation of core program components. Fidelity is the extent to which the realized intervention (tTx) is faithful to the pre-stated intervention model (TTx) Fidelity = TTx tTx We emphasize this model What to Measure Adherence to the intervention model: (1) Essential or core components (activities, processes); (2) Necessary, but not unique to the theory/model, activities, processes in addition to structures (supporting the essential components of T); in addition to (3) Ordinary features of the setting (shared with the counterfactual groups (C) Essential/core in addition to Necessary components are priority parts of fidelity assessment.
An Example of Core Components Brans as long as ds HPL Model of Learning in addition to Instruction John Brans as long as d et al. (1999) postulate that a strong learning environment entails a combination of: Knowledge-centered; Learner-centered; Assessment-centered; in addition to Community-centered components. Alene Harris developed an observation system (the VOS) that registered novel (components above) in addition to traditional pedagogy in classes. The next slide focuses on the prevalence of Brans as long as ds recommended pedagogy. Challenge-based Instruction in Treatment in addition to Control Courses: The VaNTH Observation System (VOS) Percentage of Course Time Using Challenge-based Instructional Strategies Adapted from Cox & Cordray, in press Implications Fidelity can be assessed even when there is no known benchmark (e.g., 10 Comm in addition to ments) In practice interventions can be a mixture of components with strong, weak or no benchmarks Control conditions can include core intervention components due to: Contamination Business as usual (BAU) contains shared components, different levels Similar theories, models of action But to index fidelity, we need to measure components within the control condition
Linking Intervention Fidelity Assessment to Contemporary Models of Causality Rubins Causal Model: True causal effect of X is (YiTx YiC) RCT methodology is the best approximation to the true effect Fidelity assessment within RCT-based causal analysis entails examining the difference between causal components in the intervention in addition to counterfactual condition. Differencing causal conditions can be characterized as achieved relative strength of the contrast. Achieved Relative Strength (ARS) = tTx tC ARS is a default index of fidelity Achieved Relative Strength =.15 Expected Relative Strength =.25 In Practice . Identify core components in both groups e.g., via a Model of Change Establish bench marks as long as TTX in addition to TC; Measure core components to derive tTx in addition to tC e.g., via a Logic model based on Model of Change With multiple components in addition to multiple methods of assessment; achieved relative strength needs to be: St in addition to ardized, in addition to Combined across: Multiple indicators Multiple components Multiple levels (HLM-wise) We turn to our examples .
Assessing Implementation Fidelity in the Lab in addition to in Classrooms: The Case of a Motivation Intervention Chris S. Hulleman V in addition to erbilt University PERCEIVED UTILITY VALUE INTEREST PERFORMANCE MANIPULATED RELEVANCE Adapted from: Hulleman (2008); Hulleman, Godes, Hendricks, & Harackiewicz (2008); Hulleman & Harackiewicz (2008); Hulleman, Hendricks, & Harackiewicz (2007); Eccles et al. (1983); Wigfield & Eccles (2002); Hulleman et al. (2008) The Theory of Change Methods
Motivational Outcome g = 0.05 (p = .67) Fidelity Measurement in addition to Achieved Relative Strength Simple intervention one core component Intervention fidelity: Defined as quality of participant responsiveness Rated on scale from 0 (none) to 3 (high) 2 independent raters, 88% agreement Quality of Responsiveness
Indexing Fidelity Absolute Compare observed fidelity (tTx) to absolute or maximum level of fidelity (TTx) Average Mean levels of observed fidelity (tTx) Binary Yes/No treatment receipt based on fidelity scores Requires selection of cut-off value Fidelity Indices Indexing Fidelity as Achieved Relative Strength Intervention Strength = Treatment Control Achieved Relative Strength (ARS) Index St in addition to ardized difference in fidelity index across Tx in addition to C Based on Hedges g (Hedges, 2007) Corrected as long as clustering in the classroom (ICCs from .01 to .08)
Average ARS Index Where, = mean as long as group 1 (tTx ) = mean as long as group 2 (tC) ST = pooled within groups st in addition to ard deviation nTx = treatment sample size nC = control sample size n = average cluster size p = Intra-class correlation (ICC) N = total sample size Group Difference Sample Size Adjustment Clustering Adjustment Absolute in addition to Binary ARS Indices Where, pTx = proportion as long as the treatment group (tTx ) pC = proportion as long as the control group (tC) nTx = treatment sample size nC = control sample size n = average cluster size p = Intra-class correlation (ICC) N = total sample size Group Difference Sample Size Adjustment Clustering Adjustment Infidelity Infidelity TTx TC 100 66 33 0 Treatment Strength tC t tx 3 2 1 0 Average ARS Index (0.74)-(0.04) = 0.70
Achieved Relative Strength Indices Linking Achieved Relative Strength to Outcomes Sources of Infidelity in the Classroom Student behaviors were nested within teacher behaviors Teacher dosage Frequency of responsiveness Student in addition to teacher behaviors were used to predict treatment fidelity (i.e., quality of responsiveness).
Sources of Infidelity: Multi-level Analyses Part I: Baseline Analyses Identified the amount of residual variability in fidelity due to students in addition to teachers. Due to missing data, we estimated a 2-level model (153 students, 6 teachers) Student: Yij = b0j + b1j(TREATMENT)ij + rij, Teacher: b0j = 00 + u0j, b1j = 10 + u10j Sources of Infidelity: Multi-level Analyses Part II: Explanatory Analyses Predicted residual variability in fidelity (quality of responsiveness) with frequency of responsiveness in addition to teacher dosage Student: Yij = b0j + b1(TREATMENT)ij + b2(RESPONSE FREQUENCY)ij + rij Teacher: b0j = 00 + u0j b1j = 10 + b10(TEACHER DOSAGE)j + u10j b2j = 20 + b20(TEACHER DOSAGE)j + u20j Sources of Infidelity: Multi-level Analyses p < .001. Key Points in addition to Future Issues Identifying in addition to measuring, at a minimum, should include model-based core in addition to necessary components; Collaborations among researchers, developers in addition to implementers is essential as long as specifying: Intervention models; Core in addition to essential components; Benchmarks as long as TTx (e.g., an educationally meaningful dose; what level of X is needed to instigate change); in addition to Tolerable adaptation Points in addition to Issues Fidelity assessment serves two roles: Average causal difference between conditions; in addition to Using fidelity measures to assess the effects of variation in implementation on outcomes. Should minimize infidelity in addition to weak ARS: Pre-experimental assessment of TTx in the counterfactual condition Is TTx > TC Build operational models with positive implementation drivers Post-experimental (re)specification of the intervention: For example: MAPARS = .3(planned prof.development)+.6(planned use of data as long as differentiated instruction) Points in addition to Issues What does an ARS of 1.20 mean We need experience in addition to a normative framework: Cohen defined a small effect on outcomes as 0.20; medium as 0.50, in addition to large as 0.80 Overtime this may emerge as long as ARS
Allmendinger, Glen Founder and President
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