Reporting of Treatment Fidelity in Mindfulness-Based Intervention Trials: A Review and New Tool Using NIH Behavior Change Consortium Guidelines

Abstract

Mindfulness-based interventions (MBIs) are in the fourth decade of adaptation and testing, yet little is known about their level of treatment fidelity. Treatment fidelity is a methodological strategy used to monitor and enhance the reliability and validity of behavioral interventions. The Treatment Fidelity Workgroup of the National Institutes of Health Behavior Change Consortium (BCC) put forth recommendations covering five components of treatment fidelity: design, training, delivery, receipt, and enactment. We conducted a literature review to describe how these five components of treatment fidelity are reported in published main outcomes articles of MBI efficacy trials among adult participants. Our search yielded 202 articles, and we identified 25 (12%) described study treatment fidelity. All 25 studies reported on design, n = 24 (96%) reported on training, n = 23 (92%) reported on delivery, n = 23 (92%) reported on receipt, and n = 16 (64%) reported on enactment. Eleven (44%) articles analyzed measures of receipt and enactment with a participant outcome. Fourteen (56%) articles reported on all five fidelity components. There was high variation in the way each component was conducted and/or reported, making comparisons across articles difficult. To address the prevailing limitation that the majority of MBI efficacy studies did not detail treatment fidelity, we offer the Treatment Fidelity Tool for MBIs adapted from the BCC guidelines to help researchers monitor and report these methods and measures in a simple and standardized format. By using this tool, researchers have the opportunity to improve the transparency and interpretability of the MBI evidence base.

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Acknowledgements

Special thanks to Adam M. Leventhal for his support and constructive comments on manuscript conceptualization and development.

Funding

Funding support provided by (1) the National Institute on Drug Abuse (R01DA038648 to H.A. and D.B.) and co-sponsored by the National Institute on Alcohol Abuse and Alcoholism, and (2) a National Cancer Institute training grant (T32CA009492-33 to A.K.). These funding agencies had no role in the design or execution of this study.

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A.K.: study conceptualization, methodology, literature search, data extraction, and lead of manuscript writing. H.A.: study conceptualization, methodology, funding acquisition, manuscript writing and D.B.: study conceptualization, methodology, funding acquisition, manuscript writing. All authors read and approved the final manuscript.

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Correspondence to Afton Kechter.

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Kechter, A., Amaro, H. & Black, D.S. Reporting of Treatment Fidelity in Mindfulness-Based Intervention Trials: A Review and New Tool Using NIH Behavior Change Consortium Guidelines. Mindfulness 10, 215–233 (2019). https://doi.org/10.1007/s12671-018-0974-4

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Keywords

  • Mindfulness-based intervention
  • Treatment fidelity
  • Implementation
  • Methodology
  • Tool