Present:

»  to act as a resource for the investigators on treatment delivery issues (e.g., assist with design issues, measurement of treatment fidelity and adherence, provide references and materials to the investigator group, etc.).

»  to act as a source of information about how the various studies are addressing treatment fidelity and adherence issues (e.g., design of this aspect of the study; measures used).

»  to organize subsets of investigators who are interested in developing substudies involving fidelity/adherence, e.g., some groups of investigators may use common measures of fidelity/adherence and eventually pool their data.

»  to disseminate information (via presentations and published articles) on the specific methods and measures being used in the BCC studies, and to raise awareness in the health outcomes community regarding the importance of promoting and measuring treatment fidelity in behavioral intervention studies.

The group discussed the survey of PI's regarding the site-specific strategies being used to measure and promote treatment fidelity and adherence. The survey documented strategies being used in four areas: i) study design; ii)   training of providers; iii) delivery of treatment; and iv) adherence. A summary of PI responses was presented at the BCC meeting in January; however, two sites have not yet responded, and there is a need to update the responses. The following are action items to be pursued:

»  The two sites that did not respond to the survey will be asked to respond;

»  All PI's will be sent the survey again and asked to update/revise their original responses;

»  The updated responses will be put on the BCC website with contact information at each site to facilitate cross-site problem-solving and sharing of treatment fidelity strategies and measures; and

»  The information obtained will be used in a publication discussing BCC treatment fidelity strategies.

The group discussed plans for writing an article or articles which (1) review treatment fidelity methods/measures in the BCC and (2) review treatment fidelity methods/measures in the health outcome literature. A conference call between Treatment fidelity Group members and Ken Lichstein of Memphis State University, who has written on treatment fidelity issues and is involved in the NIA-funded REACH study, was discussed. Dr. Lichstein was enthusiastic about the group's publications plans, and felt that the group could contribute a great deal to raising the consciousness of the scientific community regarding the importance of treatment fidelity issues in intervention studies.

Dr. Lichstein takes an approach to treatment fidelity that is broad and focused on more than just the delivery of the intervention. His model involves three components: delivery, receipt and enactment. This model is similar to the model developed by the Treatment Fidelity group, and in fact, the model proposed by the Treatment Fidelity group is actually an extension of Dr. Lichstein's model that includes not only the three elements he proposes (delivery, receipt and enactment) but incorporates study design and training

as important components of treatment fidelity. Distinctions between elements of the two model (e.g., adherence (behavior) versus enactment (practicing cognitive skills)) were discussed by the group. Margaret Chesney noted the importance of addressing cross-cultural issues within any model of treatment fidelity (e.g., cultural appropriateness of the interventions and measurement tools in terms of ethnicity, gender, age, etc.). Dr. Lichstein has agreed to act as a consultant to the Treatment Fidelity group and will be invited to speak at the next BCC meeting.
  

Ways in which the Treatment Fidelity subgroup can be useful to the BCC were discussed; some ideas in this regard include the following:

»  initiating cross-site discussions of treatment fidelity problems and issues, perhaps on Treatment Fidelity conference calls;

»  dissemination of information regarding NIH interests in fidelity and adherence issues - e.g., provision of contact information for NIH representatives on the BCC website;

»  encouragement of cross-fertilization of ideas and activities between the Treatment Fidelity group and other NIH-sponsored groups interested in fidelity/adherence issues (e.g., the newly funded OBSSR-sponsored Adherence RFA investigator group).

»  development of future presentations regarding treatment fidelity issues to be presented at behavioral medicine meetings, including a possible workshop for SBM.

A conference call was scheduled for Monday, September 11th at 1:00 p.m. EST to continue discussion of Workgroup activities, including future collaborations and publications. Instructions for accessing the conference call is as follows:

If you have access to a federal line, dial 1-700-991-1844 and provide access number 50253.

If you do not have access to a federal line, dial 1-800-545-4387, and provide the operator with the reference number M21001.

Please note that due to the high volume of calls when dialing in, you may experience a short waiting period. In this case, the phone will keep ringing. Just disconnect and try again a few minutes later.

If you have any questions, please contact Mary Jo Smith at 301-435-0410 or Susan Czajkowski at 301-435-0406 prior to the call.