Developing a checklist to assess fidelity of training and treatment delivery of 11 for Health, a football-based health education intervention for youth

Objectives: Assessing fidelity is essential to understanding the effectiveness of behavioural interventions, yet reporting often lacks detail and consistency. This study developed and applied a fidelity checklist to evaluate both training and treatment delivery in a school-based health education intervention. This is one of the first applications of The Behaviour Change Technique Ontology to inform the development of a fidelity checklist. The checklist was created for the 11 for Health (11fH) intervention—an intervention shown to be effective in improving health for youth. Methods: Two fidelity checklists were developed, one for health education sessions and one for football sessions. The checklists comprised 24 behaviour change techniques (BCTs) identified in the intervention manual and intervention components identified by intervention creators. Training fidelity and treatment delivery were coded by three independent raters through 8 h of video observations of the training and 10 video observations of 45 min each of the delivery of the 11fH sessions using the checklists. Results: Kappa coefficients indicated moderate to substantial observer agreement. The fidelity of training was 98.9% and the fidelity of delivery was 77.5%. Fidelity was high for items such as ‘Instruct how to perform a behaviour’ and ‘Student inclusion’, whereas the BCTs ‘Inform about emotional and social consequences’ and ‘Substitute one behaviour with another’ were delivered with lower fidelity. Conclusion: We provide a template of how to develop and evaluate aspects of fidelity that can be used in similar health education interventions, thereby enhancing both their evaluation and implementation.