Ensuring treatment fidelity in intervention studies: Developing a checklist and scoring system within a behaviour change paradigm.
Jo Baker, Helen Stringer, Cristina McKean
PMID 37715525WHAT IT FOUND
Trainees delivering a modified Derbyshire Language Scheme often missed or changed key steps.
Clear plans and checking delivery are needed. A checklist was developed to score correct delivery and added steps that drift from the manual.
Key findings
01Participants reported that the session plan was hard to read during role-play and that they were unsure how to use the prompt hierarchy.
02The final checklist was amended to score both required delivery actions and added actions that drift from the manual, with drift items subtracted from the total.
03Two raters scored the same role-play videos in a similar way, and the later checklist version gave them closer agreement than the earlier version.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Only 10 participants took part in the focus groups and role-play, and all but two of the 12 participants were student speech and language therapists without clinical experience. The sessions were role-plays with other participants acting as children, not real preschool children receiving therapy. The role-plays used one shortened session plan and small groups, not the up to six children typical of some M-DLS sessions. The time to prepare was shorter than in clinical practice, which may have affected how faithfully participants delivered the plan. The first author was involved in training, data collection, analysis and checklist revision, so researcher bias may have influenced the findings. Participants knew each other, which may have made discussion comfortable but also may have reduced challenge to group views. The checklist has not been tested with real patients or for external validity; further validation is needed before routine audit use.
Declared interests
The authors declared no conflicts of interest. The study was funded by the Heather van der Lely Foundation.
The easy way to misread this
Do not conclude that the modified Derbyshire Language Scheme works for children or that this checklist is validated for routine use. The study tested trainees' role-play and checklist development, not patient outcomes.