Table 4.
RETURN Fidelity Strategy Summary
| BCC Recommendation | RETURN Strategy | Method (where applicable) |
|---|---|---|
| Design | ||
| Explicitly identify and use a theoretical model as a basis for the intervention and ensure the intervention components and measures are reflective of underlying theory | State theoretical underpinnings of the intervention | Published paper outlining intervention development with logic model (18) |
| Ensure consistent intervention dose and develop a monitoring plan to maintain consistency | Specify target dose (15 min), provide timings breakdown of intervention components | Incorporate dose awareness into training. Dose is an allowable adaptation for RETURN, but dose will be explored in results |
| Develop a plan for how adherence to the protocol will be monitored. Monitor both intervention delivery and assessment administration | Recordings of intervention delivery sessions of each interventionist were assessed throughout the trial. 80% fidelity threshold within each intervention component required. A fidelity scoring guidance was developed | Audio-recordings of intervention delivery sessions. Iterative development of the scoring guidance with interrater reliability measures to ensure consistent assessment administration |
| Develop a plan to record intervention protocol deviations and a method for providing timely feedback to interventionists | Use a coaching style with training. Provide monthly feedback on sessions in a transparent way, using the RETURN checklist, supplemented with booster training and site support visits | Audio-recordings of intervention delivery sessions |
| Develop a user-friendly scripted intervention manual to ensure consistency of delivery and adherence to active ingredients of the treatment | Instead of scripts, the use of easy to digest crib sheets and supporting training materials designed to be used in intervention sessions | |
| Plan for implementation setbacks | Hire float dental nurses to carry out research tasks as needed, as well as to support nurses at sites. In addition, a plan to train multiple nurses at each site | |
| Minimize contamination between conditions | Training and the development of crib sheets that set out research activities for each arm. Questions were included in the trial follow-up to explore contamination with participants | Incorporate contamination awareness into training plans, including user friendly cribs sheets. Participant self-report at follow-up |
| Training | ||
| ‘Hiring’ dental nurses to deliver the RETURN intervention | Training to incorporate ‘soft skills’ necessary to foster intervention delivery skills and increase confidence. The use of a coaching style throughout the length of the trial | Observations |
| Standardise training | Use of ‘train the trainers’ model with the same team of trainers throughout the trial, use of identical training materials for all sites, the development of a central website to house all training materials, in addition to the provision of hard copies for all dental nurses | |
| Ensure dental nurse skill acquisition | The use of tests and pass scores for all training modules, utilising different methods (written, oral and action based) | |
| Minimise ‘drift’ in dental nurse skills | Assessment of intervention sessions for all nurses throughout the trial, triggered booster training, triggered or requested reflective practice sessions, coaching style maintained | Audio-recordings of intervention delivery sessions over time |
| Accommodate dental nurse differences | On-the-job shadowing training element, which provides real-time feedback and offers tailored training to suit individual needs | Observations |
| Enhance buy-in from dental nurses | CPD hours, training to include information about potential patient benefit, inclusion of soft skills development in dental nurse training, including dental nurses in early discussions with dental sites, regular engaging newsletters aimed at dental nurses, engagement lunches, regular site visits, use of communication modes congruent with dental nurse preferences, awards evening to reward achievements | |
| Delivery | ||
| Use a scripted curriculum or treatment manual | Instead of scripts, provision of a training manual with cheat sheets, cribs sheets and videos. In addition, some of the intervention materials were used as a ‘script’ to enhance standardisation | |
| Assess nonspecific effects through multiple methods and on an ongoing basis | Scored using the RETURN checklist throughout the trial, with feedback provided where necessary | Observations and audio-recordings |
| Ensure both adherence to the protocol and competency of intervention delivery | Scored using the RETURN checklist, with 100% scored at the end of the trial to provide an overview of adherence and competency in the trial | Observations and audio-recordings |
| Receipt | ||
| Ensure participants’ understanding of the intervention | The intervention was developed with the target population at the heart of its design, ensuring the intervention was engaging, culturally relevant and aesthetically pleasing. The intervention was presented in multiple formats to engage different learning styles. The intervention materials were developed to an appropriate reading age to facilitate health literacy inclusivity. Reciprocity is embedded within the intervention delivery, and enhancement of patient understanding embedded within the structure of the intervention session | Observations, audio-recordings |
| Ensure participants’ ability to perform behavioural skills | Goal and action plan facilitation is a component of the intervention where behavioural skills will be articulated. Training focuses on how to facilitate tailored goals and action plan setting. A follow-up text message forms part of the intervention to encourage behavioural skills. Questions around behaviour skills forms part of the trial follow-up with participants. Intention setting is included as part of the intervention where behavioural skills will be reaffirmed. Audio-recordings were scored against the RETURN checklist | Observations, audio-recordings, participant self-report |
| Enactment | ||
| Participant performance of the intervention skills will be assessed in settings in which the intervention might be applied | Questions were included in the 6-month telephone follow-up around enactment of the intervention skills | Participant self-report |