Delivering Virtual Group Interventions for Youth With Persisting Symptoms After Concussion (Move&Connect-Youth) and Their Caregivers (Move&Connect-Caregivers): Fidelity and Engagement Evaluation.

BACKGROUND: Youth with persisting symptoms after concussion (PSaC) can experience ongoing physical, cognitive, and emotional challenges, and their caregivers experience increased stress. There are currently limited interventions that support youth with PSaC or their caregivers. Move&Connect is a virtual group program with 2 parallel interventions: Move&Connect-Youth (M&C-Y) and Move&Connect-Caregivers (M&C-C). M&C-Y includes concussion education, active rehabilitation, and goal setting. M&C-C uses psychoeducation and practical tools to promote family communication and problem solving. OBJECTIVE: Within the context of a broader pilot study of M&C-Y and M&C-C, we completed a fidelity and engagement evaluation with the objectives of (1) evaluating intervention fidelity and (2) exploring facilitators and barriers to youth and caregiver engagement. METHODS: M&C-Y and M&C-C were delivered virtually using Zoom Healthcare and ran in parallel. Youth with PSaC and caregivers were recruited from a children's rehabilitation hospital in Ontario, Canada. Intervention fidelity was evaluated according to the 5 principles of fidelity from Bellg et al: design, training, delivery, receipt, and enactment. Intervention delivery, attendance, and engagement ratings were monitored through weekly logs and field notes. Participants completed exit satisfaction surveys, and a subset of youth and caregivers completed semistructured interviews to understand facilitators and barriers to engagement. Descriptive statistics were used to analyze logs and surveys. Directed content analysis, guided by a motivational framework, and inductive coding to identify barriers and facilitators to engagement were applied to qualitative data. RESULTS: A total of 34 youth (age: mean 15.1, SD 2.28 years) and 36 caregivers (age: mean 48.9, SD 5.92 years) participated in 10 M&C-Y and 9 M&C-C groups, respectively. Most youth identified as girls (24/34, 71%), and most caregivers identified as mothers (30/36, 83%). Clinician facilitators adhered to the components of the intervention protocols between 92% and 97% of the time in M&C-Y and 82% and 93% of the time in M&C-C. The majority of youth (22/34, 65%) and caregivers (24/36, 67%) attended 5 or more sessions. In addition, 82% (28/34) of youth and 94% (34/36) of caregivers agreed they would recommend the interventions to others. Qualitative findings revealed youth engagement was supported by motivation, comfort in the virtual setting, interactive intervention components, feelings of trust, and diverse and modifiable exercises. Barriers to youth engagement included ongoing symptoms, discrepancies between exercises and physical abilities, and previous knowledge of education. Caregiver engagement was facilitated by perceived benefits of M&C-C, emotional connection and validation, and comfort and convenience of the virtual setting. Barriers to caregiver engagement included stress, competing scheduling demands, and limited reminders or access to intervention materials. CONCLUSIONS: The pilot study of M&C-Y and M&C-C was conducted with high delivery adherence. Exit satisfaction surveys combined with qualitative data revealed high levels of caregiver satisfaction and engagement, whereas youth satisfaction and engagement had some variability, particularly related to the exercise. Findings demonstrate important implications for delivering virtual group interventions for youth with PSaC and their caregivers.