Implementation fidelity of a voluntary sector-led diabetes education programme

Michelle S Y Kok, Matthew Jones, Emma Solomon-Moore, Jane R Smith

Research output: Contribution to journalArticle (Academic Journal)peer-review

2 Citations (Scopus)
217 Downloads (Pure)


Purpose: The quality of voluntary sector-led community health programmes is an important concern for service users, providers and commissioners. Research on the fidelity of programme implementation offers a basis for assessing and further enhancing practice. This paper reports on the fidelity assessment of Living Well, Taking Control (LWTC) – a voluntary sector-led, community-based education programme in England focusing on the prevention and management of type 2 diabetes.

Design/methodology/approach: This fidelity of implementation study was conducted with the Devon-based LWTC programme. A fidelity checklist was developed to analyse audio records of group-based lifestyle education sessions – implementation was rated in terms of adherence to protocol and competence in delivery; the influence of wider contextual factors was also assessed. Kappa statistics (κ) were used to test for inter-rater agreement. Course satisfaction data were used as a supplementary indicator of facilitator competence.

Findings: Analysis of 28 sessions, from five diabetes prevention and two diabetes management groups (total participants, n=49), yielded an overall implementation fidelity score of 77.3% for adherence (moderate inter-rater agreement, κ=0.60) and 95.1% for competence (good inter-rater agreement, κ=0.71). The diabetes prevention groups consistently achieved higher adherence scores than the diabetes management groups. Facilitator competence was supported by high participant satisfaction ratings.

Originality/value: An appropriate level of implementation fidelity was delivered for the LWTC group-based education programme, which provides some confidence that outcomes from the programme reflected intervention effectiveness. This study demonstrates the viability of assessing the fidelity of implementation in a voluntary sector-led public health initiative and the potential of this method for assuring quality and informing service development.
Original languageEnglish
Pages (from-to)62-81
Number of pages20
JournalHealth Education
Issue number1
Publication statusPublished - 1 Jan 2018


  • Competence
  • Diabetes
  • Health education
  • Implementation
  • Voluntary sector

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