Mediators of complex intervention fidelity: the Falls Management Exercise Programme (FaME)

Background<br/>When implementing multicomponent interventions, fidelity to the intervention is key for reproducible outcomes. This study investigates the main influences on the fidelity of the community-based Falls Management Exercise (FaME) programmes in three different areas of England.<br/><br/>Methods<br/>FaME classes across Greater Manchester (GM), Devon and the East Midlands (EM) were studied between 2021-23 using a mixed-methodological approach. Data sources included interviews, observations of FaME classes, field notes, and communities of practice recordings. <br/><br/>Results<br/>Forty interviews were conducted with stakeholders, providers and class attendees. Additionally, twenty-one class observations were conducted. Triangulated quantitative and qualitative data revealed issues with fidelity to the FaME programme, especially in sites with limited oversight roles/structures and limited funding. There was a lack of understanding and clarity of essential components within the delivery of the programme. This resulted in reduced adherence to the underlying evidence base. The implementation fidelity framework we developed highlights the importance of mediators in implementation and delivery including: economic influence, organisational influence, oversight roles, fidelity evaluation, participant responsiveness, essential components and knowledge, training and professionalism. <br/><br/>Conclusion<br/>Despite a recognised need for implementing evidence-based falls prevention programmes, a lack of formalised oversight roles/structures and understanding of essential intervention components is associated with lower delivery fidelity. Unchecked by local monitoring, this can lead to an incremental migration of delivery away from the evidence base. We recommend: i) providers have clarity on essential intervention components, ii) standardised fidelity monitoring based on essential components, and iii) effective local oversight roles and structures.