By the book: Examining diabetes prevention program coaches’ session content delivery fidelity


There is extant research examining the effectiveness of health behaviour change programs on clinical outcomes. Examining the fidelity of such programs is equally as critical to ensure these programs are delivered as intended. To increase the probability of program effectiveness, programs must be delivered with high levels of fidelity. One way to examine delivery fidelity is using the Kirkpatrick framework. The third level of the Kirkpatrick framework assesses the extent to which coaches enact a behaviour (i.e., deliver program content) as intended. Small Steps for Big Changes (SSBC) is a diabetes prevention program delivered over six one-on-one sessions to individuals at risk of developing type 2 diabetes. SSBC coaches are trained to deliver exercise- and diet-related information to clients during sessions. The objective of this study was to examine the level of fidelity that SSBC coaches delivered program content. Methods: Nine fitness facility staff were trained to deliver SSBC to clients. For each session, coaches completed checklists to self-report the program content that they delivered. All sessions between coaches and clients were audio-recorded. One session per client was randomly selected for fidelity assessment. Self-report checklists were assessed by one coder, and two independent coders reviewed session transcripts to assess program content fidelity. Results: On average, coaches self-reported delivering 96% of program session content, and transcript analyses indicated coaches successfully delivered 89% of program session content. Conclusion: SSBC sessions were delivered with high levels of fidelity. These findings increase confidence that SSBC program results are due to the intervention content.