Table 1

Lifestyle Matters fidelity assessment framework and results

Element	Fidelity criteria	Fidelity standard	Standard met	Evidence
Trial design
Comparable treatment	All participants received the same programme tailored to the needs of the group/setting.	Sixteen weekly meetings offered to all participants Attendance recorded	Yes	Trial documentation, for example, information sheet 176 (11×16) weekly registers recorded
Comparable treatment		Four individual sessions offered to all participants Attendance recorded Four out-of-venue sessions offered to all participants Attendance recorded	Yes	Trial documentation, for example, information sheet 443 individual sessions offered, 143 taken up (32%) On average participants took part in four out-of-venue activities across the 16 weeks
Risk to implementation	Plan for potential issues that could affect the delivery of the Lifestyle Matters programme	A range of recruitment strategies will be implemented	Yes	Methods used included GP mail-outs, direct referrers and posters/leaflets
		A range of days and times for meetings offered, from which participants can choose	Yes	Facilitators worked flexibly Groups took place on various days of the week and times of day (AM/PM)
		Undertake three recruitment cycles in three geographical areas, to prevent saturation	Yes	Recruitment conducted in multiple areas at each site
Monitoring provider training
Standardised training and facilitator skill acquisition	All facilitators receive the same training tailored to the group/setting and engage with the training in a similar way	Completion of training exercise by facilitators	Yes	Observation by researchers of participants completing role playing exercises and group work
		Training delivered by the same trainer	Yes	Same trainer delivered all training
		Manual/CD-ROM provided to all trainees	Yes	Manual (or copy) and CD provided to all trainees
		Observation of the training session by two researchers using a content checklist	Yes	Observation by two researchers of skill transference using content checklist Checklist coding developed to observe ‘All’ participants
Monitoring intervention delivery
Standardised delivery	All facilitators using the same techniques and content from the programme	Observation using a content checklist by two researchers	Yes	Observation completed by two researchers
		75% of opportunities for completing goal setting are recorded (for individual and group)	No	Participants found concept of ‘goal setting’ difficult to understand. ‘Goal setting’ sheets provided in programme rarely used. Discussion of ‘Planning’ and ‘Wishes’ preferred
		Range of materials from the Lifestyle Matters programme received by all participants	Yes	Use of materials discussed by participants during qualitative interviews Observation of manual materials used during recorded group meetings
		Facilitators maintain reflective diaries	Yes	Used as part of supervision sessions, confirmed by facilitators and supervisors
		Registers completed for weekly meetings and individual sessions	Yes	Registers completed and recorded on the trial database
		Participant and facilitator semistructured interview topic guide	Yes	Interviews conducted with all facilitators at the end of cycle 1 and cycle 3 Interviews conducted with 10% sample of participants at the end of their programme attendance
		All participants receive certificate of attendance/achievement	Yes	Copies of certificates given to all participants across both sites
		Facilitators meet the National Health Service Band 4 equivalent job description	Yes	Facilitators selected for interview based on meeting essential criteria of job description.
Minimise drift in skills/delivery	Adherence to training content and delivery over the three cycles of the intervention	Observation using a content checklist by two researchers	Yes	Observation by two observers
		OT supervisor protocol	Yes	Protocol written and provided to supervisors and facilitators prior to the programme start
		Each facilitator will attend between 8 and 16 supervision sessions in total of which half should be delivered face to face	Yes	Interviews: Reported face-to-face contact recorded for one facilitator for 12 months. Three facilitators’ supervision started as face to face moving to a combination with telephone contact Supervisor attendance records provided for two facilitators (consent obtained)
Monitoring receipt of intervention
Participant attendance and engagement	Recording participants’ weekly attendance All participants taking part in the meetings and activities Impact of intervention on participant in terms of well-being	Registers completed by facilitator for weekly meetings and individual sessions where arranged	Yes	Interviews demonstrated that most participants took part in the programme, although not all joined every activity mainly due to health or mobility issues All registers completed and recorded
		75% of opportunities for completing goal setting are recorded (individual and group)	No	Concept of ‘goal setting’ difficult to understand by participants. ‘Planning’ or ‘Wishes’ preferred
		Participant and facilitator semistructured interview topic guide	Yes	10% sample of participants interviewed Participant behaviours observed during videoed sessions All facilitators interviewed at cycle 1 and cycle 3
		PROMS	Awaiting results	Completed PROMS recorded on trial database

Adapted from Bellg et al.29
GP, General Practitioner; OT, Occupational Therapist; PROMS, Patient Reported Outcome Measures.