Open Access Open Badges Research article

The Prevention and Reactivation Care Program: intervention fidelity matters

Annemarie JBM de Vos1*, Ton JEM Bakker2, Paul L de Vreede3, Jeroen DH van Wijngaarden1, Ewout W Steyerberg3, Johan P Mackenbach3 and Anna P Nieboer1

Author Affiliations

1 Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands

2 Department R & D, Argos Zorggroep, P.O. Box 4023, 3102, GA, Schiedam, The Netherlands

3 Department of Public Health, Erasmus Medical Centre Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands

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BMC Health Services Research 2013, 13:29  doi:10.1186/1472-6963-13-29

Published: 26 January 2013



The Prevention and Reactivation Care Program (PReCaP) entails an innovative multidisciplinary, integrated and goal oriented approach aimed at reducing hospital related functional decline among elderly patients. Despite calls for process evaluation as an essential component of clinical trials in the geriatric care field, studies assessing fidelity lag behind the number of effect studies. The threefold purpose of this study was (1) to systematically assess intervention fidelity of the hospital phase of the PReCaP in the first year of the intervention delivery; (2) to improve our understanding of the moderating factors and modifications affecting intervention fidelity; and (3) to explore the feasibility of the PReCaP fidelity assessment in view of the modifications.


Based on the PReCaP description we developed a fidelity instrument incorporating nineteen (n=19) intervention components. A combination of data collection methods was utilized, i.e. data collection from patient records and individual Goal Attainment Scaling care plans, in-depth interviews with stakeholders, and non-participant observations. Descriptive analysis was performed to obtain levels of fidelity of each of the nineteen PReCaP components. Moderating factors were identified by using the Conceptual Framework for Implementation Fidelity.


Ten of the nineteen intervention components were always or often delivered to the group of twenty elderly patients. Moderating factors, such as facilitating strategies and context were useful in explaining the non- or low-adherence of particular intervention components.


Fidelity assessment was carried out to evaluate the adherence to the PReCaP in the Vlietland Ziekenhuis in the Netherlands. Given that the fidelity was assessed in the first year of PReCaP implementation it was commendable that ten of the nineteen intervention components were performed always or often. The adequate delivery of the intervention components strongly depended on various moderating factors. Since the intervention is still developing and undergoing continuous modifications, it has been concluded that the fidelity criteria should evolve with the modified intervention. Furthermore, repeated intervention fidelity assessments will be necessary to ensure a valid and reliable fidelity assessment of the PReCaP.

Trial registration

The Netherlands National Trial Register: NTR2317

Geriatric care intervention; Intervention fidelity; Moderating factors