Cross Wendi F, McCarten Janet, Funderburk Jennifer S, Crean Hugh F, Lockman Jennifer, Titus Caitlin E, Pigeon Wilfred R
University of Rochester Medical Center, USA; Center of Excellence for Suicide Prevention, USA.
Center of Excellence for Suicide Prevention, USA.
Eval Program Plann. 2025 Apr;109:102531. doi: 10.1016/j.evalprogplan.2024.102531. Epub 2024 Dec 8.
Measuring fidelity is critical in program evaluations to assess how implementation influences outcomes. Implementer fidelity is comprised of adherence to the treatment content and competence of treatment delivery. Cognitive behavioral therapy for insomnia (CBT-I) is well-established and empirically supported with variants such as brief CBTi (bCBTi) showing promise in reducing both insomnia and depression. The impact of therapist fidelity on treatment outcomes is unknown in part because reliable measures have not been available. We developed measures of therapist fidelity for bCBT-i and assessed the impact of fidelity in the context of a pilot study with veterans in primary care.
METHODS/RESULTS: Audio recordings from 23 participants (78 % male) were coded. Therapist adherence measures were created for each session along with a single measure of therapist competence. Inter-rater reliability was established and predictive validity was determined. For total adherence, inter-rater reliability was excellent across sessions (ICC =.73 -.80). The competence measure showed good reliability across all sessions (ICC =.57) and was internally consistent (Cronbach's alpha =.75). There was only 10 % of shared variance between adherence and competence. All of the fidelity measures demonstrated associations with outcomes in the predicted direction; therapist adherence was significantly associated with decreased depression.
在项目评估中，衡量保真度对于评估实施过程如何影响结果至关重要。实施者保真度包括对治疗内容的坚持和治疗实施的能力。失眠认知行为疗法（CBT-I）已得到充分确立且有实证支持，其变体如简短CBT-I（bCBT-I）在减轻失眠和抑郁方面显示出前景。治疗师保真度对治疗结果的影响尚不清楚，部分原因是缺乏可靠的测量方法。我们开发了bCBT-I治疗师保真度的测量方法，并在一项针对初级保健退伍军人的试点研究中评估了保真度的影响。
方法/结果：对23名参与者（78%为男性）的音频记录进行了编码。为每个疗程创建了治疗师坚持度测量方法以及单一的治疗师能力测量方法。建立了评分者间信度并确定了预测效度。对于总坚持度，各疗程间评分者间信度极佳（组内相关系数ICC = 0.73 - 0.�0）。能力测量方法在所有疗程中显示出良好的信度（ICC = 0.57）且内部一致（克朗巴哈系数α = 0.75）。坚持度和能力之间只有10%的共同方差。所有保真度测量方法都显示出与预测方向的结果存在关联；治疗师坚持度与抑郁减轻显著相关。
