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Implementation fidelity of a voluntary sector-led diabetes education programme

Kok, Michele; Jones, Mat; Solomon-Moore, Emma; Smith, Jane


Emma Solomon-Moore

Jane Smith


© 2018, © Michele S.Y. Kok, Mat Jones, Emma Solomon-Moore and Jane R. Smith. 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. The purpose of this paper is to report on the fidelity assessment of Living Well Taking Control (LWTC) – a voluntary sector-led, community-based education programme in England focussing on the prevention and management of type 2 diabetes. Design/methodology/approach: This fidelity of implementation (FoI) 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 per cent for adherence (moderate inter-rater agreement, κ=0.60) and 95.1 per cent 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 FoI in a voluntary sector-led public health initiative and the potential of this method for assuring quality and informing service development.


Kok, M., Jones, M., Solomon-Moore, E., & Smith, J. (2018). Implementation fidelity of a voluntary sector-led diabetes education programme. Health Education, 118(1), 62-81.

Journal Article Type Article
Acceptance Date Oct 3, 2017
Online Publication Date Dec 12, 2017
Publication Date Jan 1, 2018
Deposit Date Oct 6, 2017
Journal Health Education
Print ISSN 0965-4283
Publisher Emerald
Peer Reviewed Peer Reviewed
Volume 118
Issue 1
Pages 62-81
Keywords implementation fidelity, adherence, competence, diabetes education, voluntary sector
Public URL
Publisher URL
Additional Information Additional Information : This is the accepted version of the article which is published at:


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