Implementation Fidelity of an Online Integrated Healthy Lifestyle Service During COVID-19: A Process Evaluation

Background: It is recommended that process evaluations of implementation fidelity become an integral part of the conduct of all digital health behaviour intervention research. The current study evaluated implementation fidelity of an Integrated Healthy Lifestyle Service (IHLS) during the COVID-19 lockdown.
Methods: A pragmatic sample of 167 online surveys were conducted across IHLS staff (n= 44) and clients (n= 123).
Results: A positive degree of online implementation fidelity was demonstrated during the COVID-19 lockdown for IHLS staff and clients alike across the key themes of integration, training, support, session delivery and content, and health benefits. Mixed degrees of online implementation fidelity were noted across the key themes of key performance indicators (KPIs), client engagement, and perceived competence. Lessons learned show that incorporating a bottom-up approach to information dissemination and rapid feedback from commissioners through to ground level staff, in particular in relation to KPI targets, is necessary for ensuring that programme targets are fully understood and agreed upon. The majority of IHLS clients were able to access and engage with online IHLS sessions successfully.
Conclusion: This process evaluation represents one of the first efforts to document how an ongoing IHLS was adapted as a result of the COVID-19 pandemic. In the context of behavioural health interventions, the ubiquity of digital technologies and their adoption into day-to-day life translates into greater potential reach than traditional interventions, and consequently, greater potential for positive public health impact.