Fidelity to what?

Report
A Procedure for Assessing
Fidelity of Implementation
in Experiments Testing Educational
Interventions
Michael C. Nelson1, David S. Cordray1, Chris S.
Hulleman2, Catherine L. Darrow1, & Evan C.
Sommer1
1Vanderbilt
1
University, 2James Madison University
Purposes of Paper:

To argue for a model-based approach for assessing
implementation fidelity

To provide a template for assessing implementation
fidelity that can be used by intervention developers,
researchers, and implementers as a standard approach.
2
Presentation Outline
I.
What is implementation fidelity?
II.
Why assess implementation fidelity?
III.
A five-step process for assessing implementation fidelity
IV.
Concluding points
3
A Note on Examples:
•
Examples are drawn from our review of (mainly)
elementary math intervention studies, which we are
currently deepening and expanding to other subject areas
•
Examples for many areas are imperfect or lacking
•
As our argument depends on having good examples of
the most complicated cases, we appreciate any valuable
examples to which you can refer us
([email protected])
4
What Is Implementation Fidelity?
5
What is implementation fidelity?

Implementation fidelity is the extent to which the
intervention has been implemented as expected

Assessing fidelity raises the question: Fidelity to what?
Our answer: Fidelity to the intervention model.

Background in “theory-based evaluations” (e.g., Chen,
1990; Donaldson & Lipsey, 2006)

6
Why Assess Implementation
Fidelity?
7
Fidelity vs. the Black Box
The intent-to-treat (ITT) experiment identifies the effects
of causes:
Treatment “Black Box”
Intervention’s
Causal
Processes
Assignment to
Condition
Outcome
Measures
Outcomes
Outcome
Measures
Control “Black Box”
Business As Usual
Causal
Processes
8
Outcomes
Fidelity vs. the Black Box
…While fidelity assessment “opens up” the black box to
explain the effects of causes:
Intervention “Black Box”
Assignment to
Condition
9
Intervention
Component
Mediator
Fidelity
Measure 1
Fidelity
Measure 2
Outcome
Outcome
Measure
Fidelity assessment allows us to:

Determine the extent of construct validity and external
validity, contributing to generalizability of results
10
Fidelity assessment allows us to:


Determine the extent of construct validity and external
validity, contributing to generalizability of results
For significant results, describe what exactly did work
(actual difference between Tx and C)
11
Fidelity assessment allows us to:



Determine the extent of construct validity and external
validity, contributing to generalizability of results
For significant results, describe what exactly did work
(actual difference between Tx and C)
For non-significant results, it may explain why beyond
simply “the intervention doesn’t work”
12
Fidelity assessment allows us to:




Determine the extent of construct validity and external
validity, contributing to generalizability of results
For significant results, describe what exactly did work
(actual difference between Tx and C)
For non-significant results, it may explain why beyond
simply “the intervention doesn’t work”
Potentially improve understanding of results and future
implementation
13
Limitations of Fidelity Assessment:

Not a causal analysis, but it does provide evidence for
answering important questions
14
Limitations of Fidelity Assessment:


Not a causal analysis, but it does provide evidence for
answering important questions
Involves secondary questions
15
Limitations of Fidelity Assessment:



Not a causal analysis, but it does provide evidence for
answering important questions
Involves secondary questions
Field is still developing and validating methods and tools
for measurement and analysis
16
Limitations of Fidelity Assessment:




Not a causal analysis, but it does provide evidence for
answering important questions
Involves secondary questions
Field is still developing and validating methods and tools
for measurement and analysis
Cannot be a specific, one-size-fits-all approach
17
A Five Step Process for Assessing
Fidelity of Implementation
1.
2.
3.
4.
5.
Specify the intervention model
Identify fidelity indices
Determine index reliability and validity
Combine fidelity indices*
Link fidelity measures to outcomes*
*Not always possible or necessary
18
Step 1: Specify the Intervention
Model
19
The Change Model
•
A hypothetical set of constructs and relationships among
constructs representing the core components of the
intervention and the causal processes that result in
outcomes
20
The Change Model
•
•
A hypothetical set of constructs and relationships among
constructs representing the core components of the
intervention and the causal processes that result in
outcomes
Should be based on theory, empirical findings, discussion
with developer, actual implementation
21
The Change Model
•
•
•
A hypothetical set of constructs and relationships among
constructs representing the core components of the
intervention and the causal processes that result in
outcomes
Should be based on theory, empirical findings, discussion
with developer, actual implementation
Start with Change Model because it is sufficiently abstract
to be generalizable, but also specifies important
components/processes, thus guiding operationalization,
measurement, and analysis
22
Change Model: Generic Example
23
Intervention
Component
Mediator
Outcome
Teacher
training in use
of educational
software
Teachers assist
students in using
educational
software
Improved
student
learning
Change Model: Project LINCS
Instruction in
geometry
Increase in
teacher
knowledge of
geometry
Improved
teacher
instructional
practice
Instruction in
student
cognition of
geometry
Increase in
teacher
knowledge of
student
cognition
Adapted from Swafford, Jones, and Thornton, 1997
24
The Logic Model

The set of resources and activities that operationalize the
change model for a particular implementation
25
The Logic Model

The set of resources and activities that operationalize the
change model for a particular implementation

A roadmap for implementation
26
The Logic Model

The set of resources and activities that operationalize the
change model for a particular implementation

A roadmap for implementation

Derived from the change model with input from
developer and other sources (literature, implementers,
etc.)
27
Logic Model: Project LINCS
Instruction in
geometry
Increase in teacher
knowledge of geometry
Geometry
content course
Improved
teacher
instructional
practice
What is taught
How it is
taught
Instruction in
student cognition of
geometry
Research seminar
on van Hiele
model
Increase in teacher
knowledge of student
cognition
Adapted from Swafford, Jones, and Thornton, 1997
28
Characteristics
teachers
display
A Note on Models and Analysis:
Recall that one can specify models for both the treatment
and control conditions.
The “true” cause is the difference between conditions, as
reflected in the model for each.
Using the change model as a guide, one may design
equivalent indices for each condition to determine the
relative strength of the intervention (Achieved Relative
Strength, ARS).
This approach will be discussed in the next presentation
(Hulleman).
29
Steps 2 and 3: Develop Reliable and
Valid Fidelity Indices and Apply to
the Model
30
Examples of Fidelity Indices





Self-report surveys
Interviews
Participant logs
Observations
Examination of permanent products created during the
implementation process
31
Index Reliability and Validity



Both are reported inconsistently
Report reliability at a minimum, because unreliable indices
cannot be valid
Validity is probably best established from pre-existing
information or side studies
32
Index Reliability and Validity




Both are reported inconsistently
Report reliability at a minimum, because unreliable indices
cannot be valid
Validity is probably best established from pre-existing
information or side studies
We should be as careful in measuring the cause as we are in
measuring its effects!
33
Selecting Indices
•
Guided foremost by the change model: identify core
components as those that differ significantly between
conditions and upon which the causal processes are
thought to depend
34
Selecting Indices
•
•
Guided foremost by the change model: identify core
components as those that differ significantly between
conditions and upon which the causal processes are
thought to depend
Use the logic model to determine fidelity indicator(s) for
each change component
35
Selecting Indices
•
•
•
Guided foremost by the change model: identify core
components as those that differ significantly between
conditions and upon which the causal processes are
thought to depend
Use the logic model to determine fidelity indicator(s) for
each change component
Base the number and type of indices on the nature and
importance of each component
36
Selecting Indices: Project LINCS
Change Model
Construct
Logic Model
Indicators
Indices
None; Proposed:Teacher
attendance, content delivery
None; Proposed: Head
count, observation
Research seminar None; Proposed:Teacher
van Hiele model attendance, content delivery
None; Proposed: Head
count, observation
Components
Instruction in geometry Geometry
content course
Instruction of student
cognition of geometry
Increase of teacher
None
knowledge of geometry
Ability to apply geometry
knowledge
Pre/post test of
geometry knowledge
Increase of teacher
knowledge of student
cognition
Improved teacher
instructional practice
None
Ability to describe student
cognition
Pre/post test of van
Hiele levels
What is taught
Alignment of lesson content
with van Hiele levels
Observations
Improved teacher
instructional practice
How it is taught
Particular instructional
behaviors of teachers
Observations
Improved teacher
instructional practice
Characteristics
teachers display
Reflecting knowledge of
student cognition in planning
Lesson plan task
Adapted from Swafford, Jones, and Thornton, 1997
37
Step 4: Combining Fidelity Indices*
38
Why Combine Indices?


*May not be possible for the simplest models
*Depends on particular questions
39
Why Combine Indices?





*May not be possible for the simplest models
*Depends on particular questions
Combine within component to assess fidelity to a
construct
Combine across components to assess phase of
implementation
Combine across model to characterize overall fidelity and
facilitate comparison of studies
40
Some Approaches to Combining Indices:
•
•
Total percentage of steps implemented
Average number of steps implemented
41
Some Approaches to Combining Indices:
•
•
Total percentage of steps implemented
Average number of steps implemented
HOWEVER: These approaches may underestimate or
overestimate the importance of some components!
42
Some Approaches to Combining Indices:
•
•
Total percentage of steps implemented
Average number of steps implemented
HOWEVER: These approaches may underestimate or
overestimate the importance of some components!
•
•
Weighting components based on the intervention model
Sensitivity analysis
43
MAP Example
Weighting of training sessions for the MAP
intervention
Training
Session
Session 1
Month
Content
Initial Weight
September
Administration
.25
Adjusted
Weight
.10
Session 2
October
Data use
.25
.30
Session 3
November
.25
.50
Session 4
May
Differentiated
Instruction
Growth and
planning
.25
.10
Cordray, et al (Unpublished)
44
Step 5: Linking Fidelity Measures to
Outcomes*
45
Linking Fidelity and Outcomes
•
•
•
•
•
•
*Not possible in (rare) cases of perfect fidelity (no
covariation without variation)
*Depends on particular questions
Provide evidence supporting the model (or not)
Identify “weak links” in implementation
Point to opportunities for “boosting” strength
Identify incorrectly-specified components of the model
46
Assessment to Instruction (A2i)



Teacher use of web-based software for differentiation of
reading instruction
Professional developmentStudents use A2i Teachers
use A2i recommendations for grouping and lesson
planningStudents improve learning
Measures: Time teachers logged in, observation of
instruction, pre/post reading
(Connor, Morrison, Fishman, Schatschneider, and Underwood, 1997)
47
Assessment to Instruction (A2i)




Used Hierarchical Linear Modeling to analyze
Overall effect size of .25 Tx vs. C
Pooling Tx+C, teacher time using A2i accounted for 15%
of student performance
Since gains were greatest among teachers who both
attended PD and were logged in more, concluded both
components were necessary for outcome
(Connor, Morrison, Fishman, Schatschneider, and Underwood, 1997)
48
Some Other Approaches to Linking from the
Literature
•
•
•
•
Compare results of hypothesis testing (e.g., ANOVA)
when “low fidelity” classrooms are included or excluded
Correlate overall fidelity index with each student
outcome
Correlate each fidelity indicator with the single outcome
Calculate Achieved Relative Strength (ARS) and use HLM
to link to outcomes
49
Concluding points
50
In Summary:

If we do not know what we are testing, we cannot
know what the results of our tests mean.
51
In Summary:


If we do not know what we are testing, we cannot
know what the results of our tests mean.
Model-based (change and logic) assessment
answers the question “Fidelity to what?”
52
In Summary:



If we do not know what we are testing, we cannot
know what the results of our tests mean.
Model-based (change and logic) assessment
answers the question “Fidelity to what?”
There is a need for a systematic approach to
fidelity assessment, which we describe
53
In Summary:




If we do not know what we are testing, we cannot
know what the results of our tests mean.
Model-based (change and logic) assessment
answers the question “Fidelity to what?”
There is a need for a systematic approach to
fidelity assessment, which we describe
Most useful when research designs are able to
incorporate this process from early stages
54
In Summary:





If we do not know what we are testing, we cannot
know what the results of our tests mean.
Model-based (change and logic) assessment
answers the question “Fidelity to what?”
There is a need for a systematic approach to
fidelity assessment, which we describe
Most useful when research designs are able to
incorporate this process from early stages
Additional examples and refinement of
measurement and analytical tools are needed
55
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