Implementing Dementia Caregiver Programs in Real-World Settings: Fidelity Considerations.
Yeji Hwang, Nancy A Hodgson, Laura N Gitlin
PMID 38036027WHAT IT FOUND
Across 31 real-world dementia caregiver programs, fidelity was defined and measured inconsistently, mainly as sessions delivered.
In occupational therapy programs, therapists reported documentation difficulties; one training comparison found added training did not improve adherence.
Key findings
01Of 31 studies, 20 referenced fidelity, and 11 of those measured fidelity.
02When fidelity was measured, adherence to content and dose was the main dimension assessed, in 10 of 11 studies.
03Therapists reported difficulty documenting treatment (75%) and problem-solving with caregivers (62%); in a separate training comparison, added interdisciplinary training did not improve adherence.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only 20 of 31 studies referenced fidelity, and only 11 of those measured it, so the summary rests on a subset of the included studies. Fidelity was mostly measured as adherence to content and dose. Quality of delivery, caregiver responsiveness, and organizational context were rarely considered. Fidelity results were reported in only 7 of 11 studies that measured fidelity, and only 7 of 31 studies reported how fidelity related to outcomes. Some fidelity measures were investigator-developed scoring forms, which are not comparable across studies and can be prone to positive response bias. Audio recordings are time-consuming and labor-intensive.
Declared interests
The authors declared no conflicts of interest. No funder role in design or reporting is stated in the supplied text.
The easy way to misread this
Do not read this as evidence that dementia caregiver programs work or that better fidelity improves outcomes. It reviewed how fidelity was defined and measured, and only 7 of 31 studies reported the relationship between fidelity and outcomes.