Intervention fidelity within interventions aimed at reducing non-indicated imaging for low back pain

Non-indicated imaging for low back pain (LBP) is unnecessary but remains common. Interventions to reduce this behaviour must consider the impact of fidelity (i.e., degree to which the intervention was delivered as intended) on trial results. The thesis examines strategies used to enhance and assess intervention fidelity for interventions targeting nonindicated imaging for LBP and explores perceived barriers and enablers to enhancing fidelity of training and delivery to a proposed intervention for reducing non-indicated imaging for LBP. Two studies, a systematic review and a qualitative interview study, address these objectives. The systematic review, conducted using the PRISMA statement, found few studies reported strategies to enhance/assess fidelity. When reported, mainly enhancement strategies for fidelity to study design and intervention delivery were identified. The interview study, analysed with the Theoretical Domains Framework, found that logistical issues were a perceived barrier to attending training, while enablers were incentives and flexibility in training. Time, patient pressures, and habit were perceived barriers to intervention delivery, while enablers included enhancement strategies related to reminders and support. Findings from this thesis contribute to the development of an intervention fidelity protocol when designing an intervention to reduce non-indicated imaging for LBP in Newfoundland and Labrador, Canada