Fidelity of Peer Supported Self-Management of Chronic Pain (Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms—ECLIPSE)

Abstract

Background: ECLIPSE (Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms) is a randomized controlled trial testing peer-supported chronic pain self-management. Veterans are paired with a peer coach (also with chronic pain) for 6 months. Peer coaches (PCs) and veterans meet or talk by phone 2x/month about pain self-management strategies, and veterans receive motivation and encouragement from their PC. To determine if the intervention was delivered as intended, fidelity was assessed at the end of the intervention period. Fidelity assessment is vital to help understand reasons for an intervention’s success or failure.  

Methods: Intervention veterans were asked about the intervention’s delivery during their 6-month assessment, after intervention completion. Presence or absence of four “essential elements” of the intervention were evaluated, as well as meeting frequency.   

Results: Scoring of veteran assessments revealed 74% of PC’s discussed self-management strategies and 69% of veterans felt motivated by their PC. Only 52% discussed how to adjust strategies and 34% discussed goal-setting. PC-veteran meeting frequency varied: 16% met weekly, 21% met twice a month, 16% met once a month, and 46% met less than once a month. 47% of PC’s had greater than 75% fidelity (i.e., the presence of at least 3 of 4 elements described above).  

Conclusion and Potential Impact: About half of PC’s delivered the intervention with at least 75% fidelity. Fidelity was greater for discussing self-management strategies and motivating veterans. Results suggest that peer-supported self-management can be delivered with fidelity but PCs may need additional training to do so consistently.