Measuring fidelity of brief cognitive behavior therapy for insomnia: Development, reliability and validity

IF 2 4区社会学 Q2 SOCIAL SCIENCES, INTERDISCIPLINARY Evaluation and Program Planning Pub Date : 2024-12-08 DOI:10.1016/j.evalprogplan.2024.102531

Wendi F. Cross , Janet McCarten , Jennifer S. Funderburk , Hugh F. Crean , Jennifer Lockman , Caitlin E. Titus , Wilfred R. Pigeon

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Abstract

Purpose

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.

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短暂认知行为治疗失眠症的保真度测量：发展、信度与效度。

目的：测量保真度是评估项目实施如何影响结果的关键。实施者忠实度包括对治疗内容的坚持和治疗提供的能力。失眠的认知行为疗法（CBT-I）已经建立并得到了经验的支持，诸如简短的CBTi （bCBTi）等变体显示出减少失眠和抑郁的希望。治疗师忠诚对治疗结果的影响是未知的，部分原因是没有可靠的测量方法。我们为bCBT-i开发了治疗师忠实度的测量方法，并在初级保健退伍军人的试点研究中评估了忠实度的影响。方法/结果：对23名参与者（78% %男性）的录音进行编码。治疗师的依从性措施是为每个疗程创建的，以及治疗师能力的单一衡量标准。建立量表间信度，确定预测效度。对于总依从性，各疗程间的信度非常好(ICC =。73 .80)。能力测量在所有会话中显示出良好的信度（ICC =.57），并且内部一致（Cronbach's alpha =.75）。在依从性和能力之间只有10 %的共同方差。所有的保真度测量都与预测方向的结果相关；治疗师的依从性与抑郁症的减少显著相关。

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来源期刊

Evaluation and Program Planning SOCIAL SCIENCES, INTERDISCIPLINARY-

CiteScore

3.10

自引率

6.20%

发文量

112

期刊介绍： Evaluation and Program Planning is based on the principle that the techniques and methods of evaluation and planning transcend the boundaries of specific fields and that relevant contributions to these areas come from people representing many different positions, intellectual traditions, and interests. In order to further the development of evaluation and planning, we publish articles from the private and public sectors in a wide range of areas: organizational development and behavior, training, planning, human resource development, health and mental, social services, mental retardation, corrections, substance abuse, and education.