Background
Methods
Development of the model of how to quantify implementation in multicomponent interventions
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Which are the effective components?
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How important is fidelity compared with adaptation? That is, should the protocol be strictly followed or is there room for adapting the content to the target group, and if yes, how much?
The complex multifaceted stepped-wedge intervention
Measures
Data source | Question | Response categories | |
---|---|---|---|
Delivery (content and quality) | |||
Content (success criteria) | Instructor logbooks | Have you implemented the following according to the manual: (55 success criteria)? | Not implemented (0)/partly implemented (50)/completely implemented (100)/implemented more in depth (100) |
Quality (understanding of the day’s theme) | Instructor logbooks | ||
To which extent... | To a very large extent (100)/to a large extent (100)/some-what (50)/to a small extent (0)/to | ||
Has the activity of the day (as described in the protocol) been very small extent (0) easy to comprehend? ...did you have a clear understanding of today’s theme(s)? | |||
…do you think today’s themes were relevant? | |||
...do you think today’s themes was interesting? | |||
Qaulity (contribution to the participants’ learning) | Instructor logbooks | ||
Regarding today, to which extent have you contributed to… | To a very large extent (100)/to a large extent (100)/somewhat (50)/to a small extent (0)/to a very small extent (0) | ||
...the participants’ commitment and motivation? ...ensuring the employees’ participation in the activity? ...adapting the activity to the needs of the participants? | |||
...maintaining the participants’ attention? | |||
Quality (self-rated performance) | Instructor logbooks | ||
Suppose that your performance, at its best, is equal to 10 points. How would you rate your performance today? | 0–10 (0 = not capable to perform; 10 = best performance) (0–4 were scored 0, 5–7 were scored 50, 8–10 were scored 100) | ||
Receipt (participation and responsiveness) | |||
Participation | Instructor logbooks | ||
Attendance at session | Yes/no (0–100) | ||
Responsiveness | Intervention evaluation questionnaire, completed by the participants | ||
To which extent have you... | To a very large extent (100)/To a large extent (100)/Some-what (50)/To a small extent (0)/To a very small extent (0) | ||
Responsiveness (Satisfaction) | ...been satisfied with the physical training? ...been satisfied with the cognitive training? ...been satisfied with the ergonomics? ...been satisfied with project overall? ...all in all, found the project relevant? ...all in all, found the project interesting? | ||
Responsiveness (intervention-related social support) | The instructor supported and encouraged me? | Often (100)/always (100)/sometimes (50)/seldom (0)/never (0) | |
The group supported and encouraged me? | |||
I trusted the instructor and shared my own challenges and thoughts? | |||
I trusted the group and shared my own challenges and thoughts? | |||
Responsiveness (motivation) | Instructor logbooks | To which extent are the participants committed and motivated? | To a very large extent (100)/to a large extent (100)/somewhat (50)/to a small extent (0)/to a very small extent (0) |
Delivery of the intervention (fidelity)
Receipt of the intervention
Calculation of the implementation at organizational level and individual level
Implementation at organizational level
Implementation at the individual level
Analyses
Results
Delivery of the intervention
Participatory ergonomics (n = 172) | Physical training (n = 501) | Cognitive behavioral training (n = 80) | Total intervention (n = 753) | |||||
---|---|---|---|---|---|---|---|---|
n (%) | n (%) | n (%) | n (%) | |||||
Dose delivered (sessions held/intended) | 171 (99%) | 464 (93%) | 78 (98%) | 713 (95%) | ||||
Mean (%) | SD | Mean (%) | SD | Mean (%) | SD | Mean (%) | SD | |
Fidelity of intended sessions (n = 753) | 89 | 9 | 85 | 12 | 89 | 8 | 86 | 11 |
Content (success criteria) | 94 | 12 | 80 | 17 | 94 | 8 | 84 | 16 |
Quality (performance) | 87 | 11 | 88 | 10 | 87 | 12 | 88 | 11 |
Understanding | 92 | 9 | 93 | 7 | 88 | 13 | 92 | 9 |
Contribution | 91 | 12 | 92 | 11 | 93 | 6 | 92 | 11 |
Overall self-rated performance | 79 | 22 | 80 | 23 | 80 | 22 | 80 | 23 |
Fidelity of sessions held (n = 713) | 94 | 10 | 90 | 13 | 94 | 8 | 91 | 12 |
Content (success criteria) | 95 | 12 | 86 | 18 | 96 | 8 | 89 | 17 |
Quality (performance) | 92 | 12 | 93 | 11 | 92 | 12 | 93 | 11 |
Understanding | 97 | 10 | 98 | 7 | 92 | 14 | 97 | 9 |
Contribution | 96 | 13 | 97 | 12 | 98 | 6 | 97 | 12 |
Overall self-rated performance | 84 | 23 | 85 | 25 | 84 | 23 | 84 | 24 |
Participatory ergonomics | Physical training | Cognitive behavioral training | Total intervention | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
N
| Mean (%) | SD |
n
| Mean (%) | SD |
N
| Mean (%) | SD |
n
| Mean (%) | SD | |
Delivery | ||||||||||||
Fidelity | 583 | 92 | 10 | 427 | 91 | 6 | 353 | 95 | 7 | 351 | 93 | 4 |
Content (success criteria) | 583 | 97 | 4 | 427 | 88 | 7 | 353 | 97 | 6 | 351 | 94 | 4 |
Quality (performance) | 583 | 91 | 14 | 427 | 94 | 6 | 353 | 92 | 10 | 351 | 93 | 6 |
Understanding | 583 | 94 | 13 | 427 | 98 | 4 | 353 | 94 | 12 | 351 | 96 | 6 |
Contribution | 583 | 94 | 13 | 427 | 98 | 5 | 353 | 98 | 5 | 351 | 97 | 5 |
Overall self-rated performance | 583 | 83 | 18 | 427 | 85 | 15 | 353 | 86 | 19 | 351 | 85 | 11 |
Exposure | 594 | 63 | 22 | 594 | 34 | 29 | 594 | 45 | 42 | 594 | 48 | 26 |
Content (success criteria) | 594 | 64 | 22 | 594 | 33 | 27 | 594 | 46 | 42 | 594 | 48 | 26 |
Quality (performance) | 594 | 61 | 23 | 594 | 36 | 30 | 594 | 44 | 41 | 594 | 47 | 26 |
Understanding | 594 | 64 | 23 | 594 | 37 | 31 | 594 | 45 | 42 | 594 | 49 | 27 |
Contribution | 594 | 64 | 23 | 594 | 37 | 31 | 594 | 47 | 43 | 594 | 49 | 27 |
Overall self-rated performance | 594 | 57 | 23 | 594 | 33 | 28 | 594 | 41 | 39 | 594 | 43 | 25 |
Receipt | ||||||||||||
Responsiveness | 224 | 90 | 10 | 251 | 91 | 7 | 224 | 92 | 9 | 221 | 89 | 8 |
Satisfaction | 227 | 83 | 20 | 257 | 88 | 18 | 253 | 85 | 19 | 225 | 83 | 19 |
Social support | 269 | 93* | 14* | 269 | 93* | 14* | 269 | 93* | 14* | 269 | 93* | 14* |
Motivation | 594 | 91 | 18 | 427 | 96 | 6 | 353 | 93 | 15 | 594 | 92 | 16 |
Participation | 594 | 66 | 22 | 594 | 38 | 31 | 594 | 48 | 44 | 594 | 50 | 26 |
Implementation | 224 | 60 | 23 | 251 | 30 | 29 | 224 | 35 | 39 | 221 | 56 | 20 |
Delivery | Receipt | Implementation | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Fidelity | P value | Exposure | P value | Participation rate | P value | Responsiveness | P value | Implementation | P value | |||||||||||
n
| Mean | SD |
n
| Mean | SD |
N
| Mean | SD |
n
| Mean | SD |
n
| Mean | SD | ||||||
Total
|
351
|
93
|
4
|
593
|
48
|
26
|
594
|
50
|
26
|
221
|
89
|
8
|
221
|
56
|
20
| |||||
Delivery timings |
0.000
| 0.20 | 0.42 | 0.74 | 0.252 | |||||||||||||||
Step 1 |
86
|
92
|
5
| 126 | 50 | 22 | 126 | 53 | 21 | 54 | 89 | 7 | 54 | 54 | 17 | |||||
Step 2 |
74
|
92
|
3
| 146 | 44 | 26 | 146 | 48 | 26 | 44 | 88 | 9 | 48 | 53 | 23 | |||||
Step 3 |
93
|
95
|
4
| 158 | 48 | 27 | 158 | 50 | 28 | 56 | 90 | 6 | 60 | 56 | 23 | |||||
step 4 |
98
|
93
|
5
| 164 | 48 | 27 | 163 | 50 | 28 | 67 | 89 | 8 | 68 | 60 | 17 | |||||
Workplaces |
0.000
|
0.004
|
0.001
|
0.001
| 0.125 | |||||||||||||||
Workplace 1 |
112
|
95
|
3
|
172
|
53
|
28
|
172
|
57
|
27
|
73
|
92
|
5
| 82 | 58 | 25 | |||||
Workplace 2 |
115
|
91
|
5
|
194
|
44
|
25
|
194
|
47
|
26
|
73
|
88
|
8
| 73 | 55 | 16 | |||||
Workplace 3 |
30
|
94
|
2
|
56
|
48
|
22
|
56
|
51
|
23
|
20
|
86
|
11
| 20 | 46 | 21 | |||||
Workplace 4 |
94
|
94
|
4
|
171
|
46
|
25
|
171
|
47
|
26
|
55
|
89
|
7
| 55 | 58 | 15 | |||||
Intervention components |
0.000
|
0.000
|
0.000
|
0.000
|
0.000
| |||||||||||||||
Participatory ergonomics |
92
|
10
|
63
|
22
|
66
|
22
|
90
|
10
|
60
|
23
| ||||||||||
Physical training |
91
|
6
|
35
|
29
|
38
|
31
|
91
|
7
|
30
|
29
| ||||||||||
Cognitive behavioral training |
95
|
7
|
45
|
42
|
48
|
44
|
92
|
9
|
35
|
39
|