Fidelity and clinical competence in providing IMR 151 had total scores of ≥ 4 (range 4.00–4.54), indicating high fidelity, and seven groups (47%) had total scores of ≥ 3 and < 4 (range 3.46–3.92), indicating moderate fidelity (24). High- and low-scoring elements The degree of implementation success of the numerous fidelity IMR elements varied widely (M = 3.94, SD = 1.13) (Table 2). In Table 2, the IMR Fidelity Scale items are ranked across all groups in descending order of mean scores per item. This table shows a division above and below the cut-off score of 4 for seven high-scoring items (range of mean scores: 4.60–5.00), five moderate-scoring items (range of mean scores: 2.50–3.53), and one low-scoring item (1.80). The six moderate- and low-scoring items all involved clinical elements of IMR. Out of these, three elements were poorly implemented by nine groups (60%), including cognitive-behavioral techniques, IMR goal follow-up, and relapse prevention training. Three other elements were poorly implemented by 12–14 IMR groups (80%–93%), including the involvement of significant others, coping skills training, Table 2 Implementation of Critical Elements in 15 IMR-Groups rated on the IMR-fidelity scale Item M SD Min Max % of groups with high item rating1 Items with average rating of 'high' Program Length 5,00 0,00 5,00 5,00 15 (100%) Provision of Educational Handouts 5,00 0,00 5,00 5,00 15 (100%) Comprehensiveness of the Curriculum 4,93 0,26 4,00 5,00 15 (100%) Educational Techniques 4,93 0,26 4,00 5,00 15 (100%) Number of People in a Session or Group 4,87 0,35 4,00 5,00 15 (100%) Motivation-Based Strategies 4,67 0,62 3,00 5,00 14 (93,3%) IMR Goal Setting 4,60 0,63 3,00 5,00 14 (93,3%) Items with average rating of 'moderate' Cognitive-Behavioral Techniques 3,53 0,74 3,00 5,00 6 (40,0%) IMR Goal Follow-up 3,47 1,13 2,00 5,00 6 (40,0%) Relapse Prevention Training 3,38 0,97 2,00 5,00 6 (40,0%) Behavioral Tailoring for Medication 2,60 0,71 1,00 4,00 1 ( 6,7%) Coping Skills Training 2,50 0,73 2,00 4,00 2 (13,3%) Item with average rating of 'low' Involvement of Significant Others 1,80 1,37 1,00 5,00 3 (20,1%) Total 3,94 1,13 1 The number (%) of IMR groups with a high rating of ≥ 4 on this item.
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