Programme Fidelity in a Large Pragmatic Trial: Findings from a Process Evaluation of the Strengthening Families Programme 10-14 UK (SFP10-14UK)

Background: Fidelity evaluation is particularly important in pragmatic studies, which afford greater potential for variation than explanatory trials.  The Project SFP Cymru process evaluation has examined adherence, exposure, quality of delivery, participant engagement and programme differentiation during a randomised controlled trial of the Strengthening Families Programme (SFP10-14UK) involving more than 700 families.  SFP10-14UK was delivered by local voluntary and statutory bodies in seven areas of Wales.  Training, funding and programme manuals were provided as they would be in a non-research context and there were no special measures to control programme delivery.

Methods: Data collection comprised: thirty-three interviews with and self-report data from programme staff; observation of programme sessions; and routine data from each area.  Descriptive analyses of quantitative data were conducted with appropriate tests of significance and reliability.  A thematic framework was developed for coding and analysis of qualitative data.

Results: In this paper we present key findings from the self report data and programme observation on the extent to which the SFP10-14 was delivered with fidelity.  Key influences on programme implementation are also discussed.  These included: group size; participants’ engagement with programme content; and facilitators’ management of tensions between adherence to the manual and social interactions.

Conclusions: Findings highlight the value of examining delivery quality as well as adherence, and the importance of understanding the relationship between group dynamics and programme fidelity.  Subsequent work will assess the relationship of fidelity to outcomes.  A key limitation has resulted from difficulties in involving families in research focus groups but this has been offset by triangulation of other data.