Online Group-Based Acceptance and Commitment Therapy (ACT) for Stroke Survivors: A Study of Fidelity of Delivery Within the Wellbeing After Stroke (WAterS) Study

Stroke survivors often experience psychological difficulties, yet specialist provision is limited. The Wellbeing After Stroke (WAterS) study co-developed a nine-week, online Acceptance and Commitment Therapy (ACT) group programme designed to be delivered by non-specialist practitioners using structured, script-informed session clinical protocols. This study explored whether fidelity of delivery could be assessed, both to the clinical protocol (what was delivered) and to ACT therapeutic processes (how it was delivered). Eight practitioners were trained, and four delivered the intervention to three groups of four stroke survivors. Fidelity was assessed using a bespoke WAterS checklist, completed by practitioners after each session, and the ACT-Fidelity Measure (ACT-FM), completed by researchers rating a sub-set of recorded sessions. Practitioners delivered 92–100% of planned content, indicating high fidelity to protocol. ACT-FM ratings suggested some consistency with ACT processes, though there was variability across practitioners. These findings provide preliminary, proof-of-principle evidence that non-specialists can deliver a structured ACT-based group intervention with fidelity to protocol, and that both self-completed and observer-rated methods can feasibly assess fidelity. However, the small sample size means these results should be considered exploratory. The study highlights the potential value of these methods for informing training and fidelity assessment in future research.