What to Include in the Narrative Description of your Intervention

Describing diagnostic QI interventions in sufficient detail for replication, adaptation and capturing factors that enable success is a prerequisite to spreading new ideas and insights

Key elements of what should be documented include a description of the diagnostic quality problem, the “core function” (i.e., fundamental purpose or desired effect) of the intervention, identified causal pathways, and the benefits. Inclusion of other details such as the setting of care and contextual organizational factors will be helpful for adopters to determine if the intervention can be successfully adapted and implemented in their organization. These elements are outlined below.*

1. Why – Describe the “core function” of the intervention and the desired effect on the identified root causes. How does this intervention benefit patients?
2. What
   1. Materials – Describe any physical or informational materials used in the intervention, including those provided to participants or used in the intervention delivery or in training of intervention providers. Provide information on where the materials can be accessed (e.g., online appendix, URL).
   2. Procedures – Describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities.
3. Who provided – For each category of intervention provider (e.g., nurse, resident) describe their expertise, background and any specific training given.
4. How – Describe the modes of delivery (e.g., face-to-face or by some other mechanism, such as patient portal or telephone) of the intervention and whether it was provided individually or in a group.
5. Where – Describe the type(s) of location(s) where the intervention occurred, departments and/or institutions and their approximate size. Describe the necessary infrastructure or relevant features such as the applicable settings, clinical diagnoses/patient groups, and care processes. Describe where the QI intervention was implemented including the number of departments and/or institutions and their approximate size. Describe the characteristics of the applicable settings, clinical diagnoses/patient groups, and care processes.
6. When and how much – Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, or frequency.
7. Tailoring – If the intervention was planned to be personalized or adapted, then describe what, why, when, and how.
8. Modifications – If the intervention was modified during the course of the study, describe the changes (what, why, when, and how).
9. How well
   1. Planned – If the intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them.
   2. Actual – if the intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned.

*Adapted from Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, Lamb SE, Dixon-Woods M, McCulloch P, Wyatt JC, Chan AW, Michie S. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014 Mar 7;348:g1687. doi: 10.1136/bmj.g1687. PMID: 24609605. TIDieR Checklist available for download at: https://www.bmj.com/content/bmj/suppl/2014/03/07/bmj.g1687.DC4/hoft015329.ww3_default.pdf.