A systematic review of fidelity measurements in complex interventions for people with intellectual disabilities and behaviours that challenge
| DOI | https://doi.org/10.1108/AMHID-09-2018-0040 |
| Date | 12 June 2019 |
| Published date | 12 June 2019 |
| Pages | 158-172 |
| Author | Laura Paulauskaite,Angela Hassiotis,Afia Ali |
| Subject Matter | Health & social care |
A systematic review of fidelity
measurements in complex interventions
for people with intellectual disabilities and
behaviours that challenge
Laura Paulauskaite, Angela Hassiotis and Afia Ali
Abstract
Purpose –Fidelity data in clinical trials are not only necessary for appraising the internal and external validity,
but also could provide useful insights how to improve the application of an intervention in everyday settings.
The purpose of this paper is to understand the current literature of fidelity measurements in complex
interventions for people with intellectual disabilities (ID) and behaviours that challenge.
Design/methodology/approach –The electronic databases MEDLINE, Embase, PsycINFO, Web of
Science and CINAHL Plus were searched for studies published between 1990 to 2017 that have mentioned
fidelity in randomised controlled trials of complex interventions for people with ID and behaviours that
challenge based on positive behaviour support or applied behaviour analysis principles. The authors also
searched the grey literature and reference lists.
Findings –Five randomised controlled trials were included in the review. The authors found variable
and inconsistent fidelity measurements reported in the studies. The most frequently provided fidelity
elements found in four out of five studies were adherence of implementation, dose and some aspects of
quality of delivery.
Research limitations/implications –Research recommendations for a standardised approach of
measuring fidelity in such studies are suggested.
Originality/value –The first review of such type that confirms the paucity of research measuring fidelity in
complex interventions in this population.
Keywords Fidelity, Intellectual disability, Randomised controlled trial, Complex intervention,
Behaviours that challenge, Positive behaviour support
Paper type Research paper
Introduction
There are approximately 26,500 adults with intellectual disabilities (ID) and behaviours that
challenge in England (Emerson et al., 2011). Behaviours that challenge are enduring and often
have serious negative consequences for the person (e.g. administration of medication, abuse or
in-patient admissions) and for those who support them (e.g. physical/mental health problems or
high job turnover) (Emerson and Einfeld, 2011; Allen, 2009; Sturmey, 2009).
Currently, positive behaviour support (PBS) is considered the best practice for supporting
individuals with I D who engage in behav iours that challen ge (Department of H ealth, 2014;
British Psychological Society, 2018; NICE, 2015). PBS is a multicomponent biopsychosocial
intervention tha t aims to improve individuals’quality of life and eventually reduce the display of
behaviours that ch allenge (Positiv e Behavioural Supp ort Coalition UK, 2 015). PBS evolved
from applied behaviour analysis (ABA) that forms a central core of PBS and provides the
framework and tech niques for understa nding and reducing b ehaviours that cha llenge
(Allen, 2009). Beh aviour support plans are develope d as part of PBS to provide a step by step
Received 24 September 2018
Revised 30 November 2018
Accepted 7 January 2019
UK National Institute for Health
Research under the Health
Technology Assessment
Programme (HTA 10/104/13). The
study funder had no role in study
design, data collection, data
analysis, data interpretation or
writing of the report. The
corresponding author had full
access to all data in the study and
had final responsibility for the
decision to submit for publication.
The views expressed are those of
the author(s) and not necessarily
those of the NHS, the NIHR or
the Department of Health and
Social Care.
Laura Paulauskaite, Angela
Hassiotis and Afia Ali are all
based at Division of Psychiatry,
University College London,
London, UK.
PAGE158
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VOL. 13 NO. 3/4 2019, pp.158-172, © Emerald Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-09-2018-0040
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