Centre for Dementia

Home Support for People with Dementia : Developing a Fidelity Index

The Issue

Dementia is a major public health issue for the 21st Century for which there is presently no cure. The UK National Health Service states that in England there are 570,000 people living with dementia, and this number is expected to double over the next 30 years.

The older you get, the more likely you are to develop dementia and it remains a leading cause of dependency and disability among older people. This increasing number of people will lead to an increasing demand for care at home.

To be effective, home care for people with dementia needs to be sensitive to the special problems that they present. However, community based services are not always designed to meet the specific needs of people with dementia and their carers.

Key Facts

Study dates: November 2010 to May 2013

Funders: National Institute for Health Research, School for Social Care Research (NIHR-SSCR)

Principle investigator: Dr Rob Jones

Contact: Anthony Kelly


Study Details

What were the study aims?

This study aimed to develop an evidence based (‘what works’), service template, specifying the appropriate approaches for home support teams, and a measuring tool (a 'fidelity index') that service managers can use to self assess critical components of service delivery.

What is a "fidelity index"?

Fidelity denotes how accurate a copy is to its source; how closely a set of procedures are implemented - have they been implemented as they were supposed to have been.

Index denotes a detailed listing of topics, that directs attention to some fact, condition, or guiding principle.

A Fidelity Index measures how closely a service matches the conditions and guiding principles that might be expected from such a service.


What were the study objectives?

The primary study objectives were to:

  1. review the literature and professional guidance in order to establish a consensus agreed evidence base on the critical components of effective, efficient and successful integrated support at home by a service team for people with dementia and their carers.
  2. develop a Service Template for this support at home by such teams for people with dementia and their carers.
  3. devise a Fidelity Index (FI) for services to self-assess how faithfully the critical components are delivered.
  4. field test the FI.
  5. disseminate this work and make the FI available for service self-assessment, and audit and benchmarking.
What were your research questions?

We wanted to find out the answers to the following:

  • What works? What does the evidence and expert consensus show are the components and service characteristics necessary in order to provide effective, efficient and successful integrated support at home by a service team for people with dementia (PWD) and their carers?
  • Can managers use it? Do managers find the FI acceptable and usable as a service self audit assessment and service improvement tool?
  • Does the Fidelity Index have validity, acceptability and utility?
  • Can evidence be useful? Can evidence from the perspectives of: (a) examining service documentation, (b) the views of care workers, (c) the views of client carers and (d) the views of professionals, who know the service, be usefully added to the manager’s assessment?
  • Are managers’ assessments and any such evidence in agreement? Do they seem concordant?

Who were the participants?

The following organisations took part in the research:

  • Calverton Supreme Home Care Ltd
  • Direct Health
  • Extra Care Charitable Trust
  • Home Instead Senior Care
  • Nottingham City Council
  • Nottingham Community Housing Association
  • Mears Care
  • Percurra
  • Saga Homecare
  • Westminster Home Care

What did the study involve?

There were four phases:

  1. Completing / filling in the Fidelity Index (FI) tool
  2. Showing the researcher some of the non-confidential ‘evidence’ used in order to fill in the FI tool
  3. Distributing a short questionnaire to some of the other stakeholders of the service
  4. Participating in a short interview to determine your experience of using the FI tool


This work presents independent research commissioned by the NIHR SSCR. The views expressed are those of the authors and not necessarily those of the NIHR SSCR.


Centre for Dementia

The University of Nottingham
Institute of Mental Health
Jubilee Campus
Wollaton Road
Nottingham, NG8 1BB

telephone: +44 (0) 115 823 0421