Measures of fidelity of delivery and engagement in self-management interventions: A systematic review of measures.

BACKGROUND/AIMS: Self-management interventions are increasingly being developed and researched to improve long-term condition outcomes. To understand and interpret findings, it is essential that fidelity of intervention delivery and participant engagement are measured and reported. Before developing fidelity checklists to assess treatment fidelity of interventions, current recommendations suggest that a synthesis of fidelity measures reported in the literature is completed. Therefore, here we aim to identify what the current measures of fidelity of intervention delivery and engagement for self-management interventions for long-term conditions are and whether there is treatment fidelity. METHODS: Four databases (MEDLINE, PubMed, CINAHL Plus and ScienceDirect) and the journal implementation science were systematically searched to identify published reports from inception to December 2020 for experimental studies measuring fidelity of intervention delivery and/or participant engagement in self-management interventions for long-term conditions. Data on fidelity of delivery and engagement measures and the findings were extracted and synthesised. RESULTS: Thirty-nine articles were identified as eligible, with 25 studies measuring fidelity of delivery, 19 reporting engagement and 5 measuring both. For fidelity of delivery, measures included structured checklists, participant completed measures and researcher observations/notes. These were completed by researchers, participants and intervention leaders. Often there was little information around the development of these measures, particularly when the measure had been developed by the researchers, rather than building on others work. Eighteen of 25 studies reported there was fidelity of intervention delivery. For engagement, measures included data analytics, participant completed measures and researcher observations. Ten out of 19 studies reported participants were engaged with the intervention. CONCLUSION: In complex self-management interventions, it is essential to assess whether treatment fidelity of each core component of interventions is delivered, as outlined in the protocol, to understand which components are having an effect. Treatment fidelity checklists comparing what was planned to be delivered, with what was delivered should be developed with pre-defined cut-offs for when fidelity has been achieved. Similarly, when measuring engagement, while data analytics continue to rise with the increase in digital interventions, clear cut-offs for participant use and content engaged with to be considered an engagement participant need to be pre-determined.

Arsenic accumulation in rice (Oryza sativa L.): human exposure through food chain.

Although human exposure to arsenic is thought to be caused mainly through arsenic-contaminated underground drinking water, the use of this water for irrigation enhances the possibility of arsenic uptake into crop plants. Rice is the staple food grain in Bangladesh. Arsenic content in straw, grain and husk of rice is especially important since paddy fields are extensively irrigated with underground water having high level of arsenic concentration. However, straw and husk are widely used as cattle feed. Arsenic concentration in rice grain was 0.5+/-0.02 mg kg(-1) with the highest concentrations being in grains grown on soil treated with 40 mg As kg(-1) soil. With the average rice consumption between 400 and 650 g/day by typical adults in the arsenic-affected areas of Bangladesh, the intake of arsenic through rice stood at 0.20-0.35 mg/day. With a daily consumption of 4 L drinking water, arsenic intake through drinking water stands at 0.2mg/day. Moreover, when the rice plant was grown in 60 mg of As kg(-1) soil, arsenic concentrations in rice straw were 20.6+/-0.52 at panicle initiation stage and 23.7+/-0.44 at maturity stage, whereas it was 1.6+/-0.20 mg kg(-1) in husk. Cattle drink a considerable amount of water. So alike human beings, arsenic gets deposited into cattle body through rice straw and husk as well as from drinking water which in turn finds a route into the human body. Arsenic intake in human body from rice and cattle could be potentially important and it exists in addition to that from drinking water. Therefore, a hypothesis has been put forward elucidating the possible food chain pathways through which arsenic may enter into human body.