Table 1.

Steps of root cause analysis.

RCA step	Inputs	Outputs
Determine lapses of fidelity and categorize by domains	Delphi consensus to determine key element domains	Table 3: list of lapses in fidelity of delivery for 7 key element domains fidelity of receipt for key element domain of exercise fidelity of enactment for key element domain of exercise
	Fidelity observations of sessions to determine lapses in fidelity of delivery
	Participant interview post-session 7 (fidelity of exercise receipt, fidelity of exercise enactment)
Populate fishbone diagram with categories of primary causes to be used for RCAs	RCA team consensus regarding the categories of possible causes for fidelity lapses (i.e., bones of fish)	Bones of fish to be used with RCAs for lapses of fidelity in delivery, receipt, and enactment, by key element domain
For each RCA, brainstorm possible causes using 5-why’s technique	RCA team	Preliminary fishbone diagram for lapses of fidelity in delivery, receipt, and enactment, by key element domain
Verify root causes	RCA team members’ review of primary data: field logs of Stepping On leaders notes from expert observers interviews and surveys of participants, Stepping On leaders, site coordinators, and guest experts	Completed fishbone diagrams with root causes of lapses in fidelity of delivery, receipt, and enactment, by key element domain
		Table 4: summary of root causes by key element domain
Identify solutions	Program developer and content experts on Stepping On research team	Table 5: changes made to Stepping On program based on RCA