High Fidelity: Translating the evidence-base into real world settings

1. High Fidelity: Translating the evidence-base into real world settings Dr Jo Holliday, Research Fellow, Cardiff University Sally Good, Chief Operating Officer, DECIPHer Impact Potential conflict of interest: Sally Good is the Chief Operating Officer at DECIPHer Impact Ltd, a not-for-profit company wholly owned by the Universities of Bristol and Cardiff set up to licence and support the implementation of effective health promotion interventions.

2. Background • Health promotion interventions inherently complex

3. Background • Health promotion interventions inherently complex • Presents challenges for • standardization of delivery • evaluation • Pragmatic trials incorporating process evaluation can provide insight into • where variation occurs • why it occurs and • implications of this for wider implementation

4. Aims of study • Discuss issues of fidelity of intervention delivery encountered within A Stop Smoking in Schools Trial (ASSIST) • Describe the systems established to ensure translation of positive trial findings into real-world settings.

5. The ASSIST Programme • A school-based, peer-led smoking prevention programme • Encourages new norms of smoking behaviour by training influential Year 8 students to work as ‘peer supporters’ • Peer supporters identified as influential by peer group • Peer supporters trained during school time but off school site • Peer supporters have informal conversations with other students • Support sessions held in school

6. Evaluation of the ASSIST Programme • Evaluated in a pragmatic RCT with integral process evaluation • Involved 10,720 students from 59 schools at baseline • Demonstrated a 22 % reduction in the odds of being a regular smoker in intervention schools compared with control schools (Odds ratio 0.78 CI: 0.64-0.96) using follow-up data collected at three time points over two years

7. Methods

8. Results • Trainer to student ratios • School staff involvement • Training approach Variations observed in terms of: • Peer nomination and recruitment • Venues • Length of sessions • Intervention timetable

9. Early implementation of ASSIST • Learning from trial incorporated into detailed documentation • ‘Training the Trainers’ guide • ASSIST programme manual • Monitoring process of early roll out enabled refinement of programme • Wales • A London Borough • A Primary Care Trust in the South West

10. Quality Assurance Scores 10

11. What we have done to enable ASSIST to be implemented • Not-for-profit company - DECIPHer Impact formed in March 2010 • Wholly owned by Cardiff University and the University of Bristol • Five board directors (two from each University and an independent Chair) • Chief Operating Officer and new Chief Executive Officer • Offices near Bristol

12. What we have done to enable ASSIST to be implemented

13. Maintaining fidelity through DECIPHer Impact Ltd • Provision of training to ensure a consistently high standard • Provision of a comprehensive programme Manual and regular updates to good quality materials • Support and monitoring of implementation • A comprehensive Quality Assurance Framework including: • observation of delivery • student feedback • school feedback • self-assessment

14. Evidence-based but not prescriptive • Recognition that every customer is different • Provision of a framework and guidance to work within based on our experience of implementing the programme • Flexibility is built in and includes: • Traffic light system • Suggestions to extend or shorten activities • Examples of different ways to achieve objectives • Broad parameters to encompass different group sizes and backgrounds

15. Ongoing Customer Support through DECIPHer Impact Ltd • Academic guidance available to Company via Board of Directors • Working group provides customers with a direct conduit for feedback • Helpdesk ensures that customers can access support quickly and easily • Teleconferencing provides opportunities throughout the year for sharing best practice • Regular seminars and an annual conference enable sharing of best practice

17. Using ASSIST • Sold under licence for 3 year periods • Population based model • Banded licence fees based on the number of 10-14 year olds in a geographical area • Option for separate areas to cluster together to benefit from economies of scale • An indication of costs is £42 per student, including the licence fee, based on 6,000 students taking part in the programme over 3 years

18. UK rollout to date • Over 20,000 young people participated in 2011-2012 • Our 3 early adopters have continued to use ASSIST for over 5 years • 1 region of 13 Local Authorities • 12 individual Local Authorities • 2 Channel Islands • 1 country

19. Contact and Acknowledgements Jo Holliday, Cardiff University: hollidayj1@cardiff.ac.uk Sally Good, DECIPHer Impact: sally.good@decipher-impact.com ASSIST: Prof R Campbell, Prof L Moore, Dr J Holliday, Dr S Audrey DECIPHer Impact: Directors: Prof R Campbell, Prof L Moore; Dr G Pierce-Jones,Dr D Sheader, Dr M Hughes, CEO: M Day, COO: S Good A Stop Smoking in Schools Trial was made possible by funding from the Medical Research Council (grant number G9900538). The writing of this paper was supported by DECIPHer, a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (RES-590-28-0005), Medical Research Council, the Welsh Assembly Government and the Wellcome Trust (WT087640MA), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.