Considering current levels of overweight and obesity in the population and the associated adverse health consequences, engaging people with chronic exercise programmes is of heightened importance. During chronic structured exercise programmes, some adults experience adaptive compensatory behavioural responses through increased dietary intake and/or decreased free-living physical activity. These responses can negate the benefits of an exercise-induced energy deficit. However, it is unclear whether young people experience similar responses during chronic structured exercise. Therefore, the experimental research presented in this thesis examined the existence and extent of exercise-induced energy compensation in adolescent girls. To achieve this, a total of 92, 12 to 15 year old girls and 26 adults were recruited into six experimental studies. The Medical Research Council guidance for designing complex interventions was used to structure the experimental chapters into development (Chapters 4 to 7), piloting (Chapter 8) and evaluation (Chapter 9). The first experimental study (Chapter 4) demonstrated that typical daily variation of total energy expenditure (TEE) in adolescent girls is ~3% when estimated by the Actiheart. Physical activity energy expenditure (AEE) variation was found to be ~10%. In the second experimental study (Chapter 5) the agreement and variability of laboratory buffet meals test days was investigated. The results demonstrated typical daily variation of 8.7% in laboratory-based energy intake (EI) in adolescent girls aged 12 to 15 years. Furthermore, a buffet meals familiarisation day is recommended to reduce the variability in EI. Estimation of EI was further explored in Chapter 6 using a digital photography method. This study demonstrated potential for EI assessment using digital photography, but highlighted that, at present, a supplementary written record of EI is required to overcome the limitations associated with missing photographs. Chapter 7 explored themes related to recruitment and retention of adolescent girls to chronic exercise intervention studies. The seven recommendations identified were used to recruit and retain participants in a twelve week pilot exercise intervention study with adolescent girls (Chapter 8). There was no evidence of energy compensation behaviours on a group level; however, high individual variability in both EI and EE behaviours was apparent. The final experimental chapter (Chapter 9) evaluated the fidelity of the exercise intervention and compliance with the measurement of primary outcome variables. Intervention fidelity was largely upheld. On average, participants attended 94% of exercise sessions and 73% of the participants met their individual target heart rate zone. Focus groups with the participants and parents highlighted preference for school-based exercise sessions due to increased variety and convenience, and recommendations for future estimation of free-living EI and EE. Collectively, these studies suggest there is value in pursuing the investigation of energy compensation behaviours in adolescent girls using a mixed methods approach. These studies demonstrate the factors requiring attention when designing and delivering complex interventions to investigate exercise-induced energy compensation in adolescent girls. In particular, methods for estimating free-living EI and EE require further attention before attempting to conduct such research in a larger sample.

In schools, didactic training is a common method for promoting intervention fidelity. Despite its prevalence, however, a number of literature reviews suggest that didactic training alone is not an effective way to promote intervention fidelity. Training seems to be more effective when coupled with daily or weekly performance feedback in applied settings. However, given the level of resources in typical public schools, this amount of performance feedback for all teachers and paraprofessionals may not be feasible. Therefore, there is a need to explore additional means of promoting intervention fidelity. The current study examines the effects of fluency training on intervention fidelity by paraprofessionals in an applied setting. Results suggest that systematic fluency training can improve intervention fidelity, even when the interventions are complex and are being conducted by paraprofessionals with limited formal education. The study's findings also suggest that ongoing monitoring of implementation fidelity is necessary, because maintenance of these effects is idiosyncratic.

Pain management in hospitalized infants in the Neonatal Intensive Care Unit continues to be substandard despite the development and availability of evidence-based guidelines. The Evidence-based Practice Identification and Change (Lee et al., 2009) strategy is a multifaceted tailored intervention that has been used to promote evidence-based practice. However, the process of delivering the components of the intervention is not well understood and no valid measure for evaluating the fidelity of intervention implementation exists. The overall objective was to develop and determine the face validity, content validity, construct validity, feasibility, and clinical utility of the Process Evaluation Checklist. Three prospective studies were conducted. In Study 1, the face and content validity of the Process Evaluation Checklist was determined. In Study 2, the construct validity of the Process Evaluation Checklist was examined by assessing the fidelity of implementing the Evidence-based Practice Identification and Change intervention in a clinical setting. In Study 3, the feasibility and clinical utility of the Process Evaluation Checklist was determined. Overall, the face and content validity of the Process Evaluation Checklist was achieved. The intervention was implemented with high fidelity, supporting the construct validity of the measure. A Research Practice Council, with assistance from an external facilitator and internal facilitators, implemented multifaceted knowledge translation strategies in the form of constant reminders to improve sucrose administration practices. Post intervention admission orders were significantly more likely to include sucrose, and odds of being administered sucrose were 13 times greater compared to baseline. Beginning support was provided for the content and construct validity, feasibility, and clinical utility of the Process Evaluation Checklist for use with complex interventions. Using this measure to monitor intervention fidelity in different contexts and with different users over longer periods of time will provide additional support to the validity of the Process Evaluation Checklist.

Pain management in hospitalized infants in the Neonatal Intensive Care Unit continues to be substandard despite the development and availability of evidence-based guidelines. The Evidence-based Practice Identification and Change (Lee et al., 2009) strategy is a multifaceted tailored intervention that has been used to promote evidence-based practice. However, the process of delivering the components of the intervention is not well understood and no valid measure for evaluating the fidelity of intervention implementation exists. The overall objective was to develop and determine the face validity, content validity, construct validity, feasibility, and clinical utility of the Process Evaluation Checklist. Three prospective studies were conducted. In Study 1, the face and content validity of the Process Evaluation Checklist was determined. In Study 2, the construct validity of the Process Evaluation Checklist was examined by assessing the fidelity of implementing the Evidence-based Practice Identification and Change intervention in a clinical setting. In Study 3, the feasibility and clinical utility of the Process Evaluation Checklist was determined. Overall, the face and content validity of the Process Evaluation Checklist was achieved. The intervention was implemented with high fidelity, supporting the construct validity of the measure. A Research Practice Council, with assistance from an external facilitator and internal facilitators, implemented multifaceted knowledge translation strategies in the form of constant reminders to improve sucrose administration practices. Post intervention admission orders were significantly more likely to include sucrose, and odds of being administered sucrose were 13 times greater compared to baseline. Beginning support was provided for the content and construct validity, feasibility, and clinical utility of the Process Evaluation Checklist for use with complex interventions. Using this measure to monitor intervention fidelity in different contexts and with different users over longer periods of time will provide additional support to the validity of the Process Evaluation Checklist.

No description available.

<p>Intervention fidelity examines the degree to which an intervention is delivered as planned. Generic fidelity measures incorporate the active ingredients of more than one intervention and characteristics common to all interventions. Three studies were conducted to define the active ingredients of intervention for children with physical disabilities and generate a generic fidelity measure. These studies involved: (1) describing generic fidelity measures; (2) generating essential attributes of paediatric rehabilitation; and (3) differentiating between two interventions to consistently rate the behaviours of the therapist, child and parent.</p> <p>(1) In a narrative review of generic fidelity measures, five measures were identified within the psychotherapy literature. These measures presented a variety of approaches to examine fidelity, described psychometric property standards, and highlighted 37 non-specific intervention items that were relevant to paediatric rehabilitation.</p> <p>(2) A consensus process with eight experts and interviews with seventeen clinicians working with children with physical disabilities generated 35 attributes that highlighted the general observed therapist and client behaviours essential within a successful intervention session.</p> <p>(3) The Paediatric Rehabilitation Observational measure of Fidelity (PROF) was developed (30 items) to evaluate specific and non-specific behaviours within two occupational therapy and physiotherapy interventions for children with cerebral palsy. Six trained raters examined 25 intervention videos for psychometric testing. Results indicated that the PROF demonstrated good to excellent Inter-rater reliability and early construct validity.</p> <p>These studies present an important starting point to observe and measure the active ingredients within paediatric rehabilitation, incorporating its dynamic nature involving the child and parent within the therapy process.</p> / Doctor of Philosophy (PhD)

This study developed a summative scale that could be administered in a short time period to determine the Quality of Use (QOU) of an intervention used by teachers. The scale can be completed in less than an hour using easily attainable information. The QOU scale was applied to an elementary reading program to determine if the program results were dependent upon the quality of the fidelity of teacher use. The study focused on use of the Linguistic Pattern Series (LPS) portion of the Integrated Skills Method (ISM) Reading Program by 20 special education teachers in 13 elementary schools in San Antonio, Texas. Progress is measured by the use of the Decoding Skills Test (DST) (ISM Teaching Systems, Inc., 2004-b). To determine each teacher's QOU, a summative scale was developed composed of five items (Initial Placement, Frequency of Direct Instruction, Materials – LPS, Materials – Literature/Test Prep, and Scheduling) that possessed low-moderate cohesiveness of Alpha=.71. Results of the study showed a correlation between QOU summary scores and residualized DST Raw Score Grade Equivalent (RSGE) gains. The QOU could predict .771^2 = 50 percent of score variance. This is a strong prediction for a non-student external measure in education.

<p>The thesis presents three papers discussing some of the methodological issues regarding studies investigating complex community-based cardiovascular health interventions. All three studies involved the Cardiovascular Health Awareness Program (CHAP), a standardised blood pressure and risk factor assessment and educational sessions held in pharmacies or other locally accessible areas in small to mid-sized communities in Ontario, Canada.</p> <p>The first paper reviews the literature and proposes a guide on how to develop a theoretical framework for complex community-based interventions using CHAP as an example. The paper describes a stepwise process of developing a theoretical framework including challenges encountered and strategies employed to overcome them.</p> <p>The second paper presents how recently published randomized controlled trials evaluating complex community-based cardiovascular health interventions monitored and reported implementation fidelity based on a structured review of the published articles and a survey of their primary authors. The results showed that fidelity reporting of included studies was better than those described in previous reviews. Fidelity was verified through self-reports by implementers and supervision by researchers. Strategies described to standardize intervention delivery were through training of implementers and use of implementation guides. The authors’ survey results were consistent with the review results though there were some gaps which could be improved to strengthen fidelity reporting.</p> <p>A data analysis issue with studies investigating complex community-based interventions is that outcomes can be affected by factors from multiple levels. The third paper explores the association of individual, partnership, and community-related factors with CHAP participants’ use of health-related community resources and cardiovascular risk behaviours. This was a cross-sectional analysis of an on-going cohort study. The results showed that individual factors (age and self-efficacy) had the most consistent association with the outcomes. Community and partnership level variables showed less consistent association with the outcome. Methodological and analytical challenges were presented.</p> / Doctor of Philosophy (PhD)