Implementation fidelity refers to the degree to which an intervention or programme is delivered as intended. Only by understanding and measuring whether an intervention has been implemented with fidelity can researchers and practitioners gain a better understanding of how and why an intervention works, and the extent to which outcomes can be improved. The authors undertook a critical review of existing conceptualisations of implementation fidelity and developed a new conceptual framework for understanding and measuring the process. The resulting theoretical framework requires testing by empirical research. Implementation fidelity is an important source of variation affecting the credibility and utility of research. The conceptual framework presented here offers a means for measuring this variable and understanding its place in the process of intervention implementation.

/pdf/a-conceptual-framework-for-implementation-fidelity-544khkva0e.pdf

A conceptual framework for implementation fidelity

Adaptations of evidence-based interventions (EBIs) often occur. However, little is known about the reasons for adaptation, the adaptation process, and outcomes of adapted EBIs. To address this gap, we conducted a systematic review to answer the following questions: (1) What are the reasons for and common types of adaptations being made to EBIs in community settings as reported in the published literature? (2) What steps are described in making adaptations to EBIs? and (3) What outcomes are assessed in evaluations of adapted EBIs? We conducted a systematic review of English language publications that described adaptations of public health EBIs. We searched Ovid PubMed, PsycINFO, PsycNET, and CINAHL and citations of included studies for adapted public health EBIs. We abstracted characteristics of the original and adapted populations and settings, reasons for adaptation, types of modifications, use of an adaptation framework, adaptation steps, and evaluation outcomes. Forty-two distinct EBIs were found focusing on HIV/AIDS, mental health, substance abuse, and chronic illnesses. More than half (62%) reported on adaptations in the USA. Frequent reasons for adaptation included the need for cultural appropriateness (64.3%), focusing on a new target population (59.5%), and implementing in a new setting (57.1%). Common adaptations were content (100%), context (95.2%), cultural modifications (73.8%), and delivery (61.9%). Most study authors conducted a community assessment, prepared new materials, implemented the adapted intervention, evaluated or planned to evaluate the intervention, determined needed changes, trained staff members, and consulted experts/stakeholders. Most studies that reported an evaluation (k = 36) included behavioral outcomes (71.4%), acceptability (66.7%), fidelity (52.4%), and feasibility (52.4%). Fewer measured adoption (47.6%) and changes in practice (21.4%). These findings advance our understanding of the patterns and effects of modifications of EBIs that are reported in published studies and suggest areas of further research to understand and guide the adaptation process. Furthermore, findings can inform better reporting of adapted EBIs and inform capacity building efforts to assist health professionals in adapting EBIs.

/pdf/a-systematic-review-of-adaptations-of-evidence-based-public-47a4lt1o9x.pdf

A systematic review of adaptations of evidence-based public health interventions globally

Healthier women, healthier reproductive outcomes: recommendations for the routine care of all women of reproductive age

This article focuses on issues related to implementing school-based social and character development programs in the context of a large multiprogram evaluation study funded by the Institute of Education Sciences and the Centers for Disease Control and Prevention. Implementation analysis is a relatively new but important research area. The first section describes why this analysis is especially important when null results are obtained. It is also noted that not only does the intervention need to be documented but activities at the comparison site require explication. The wide range of implementation methods used at four of the seven sites in the Social and Character Development Research Program is described and difficulties in studying implementation at multiple sites are discussed.

Approaches to Measuring Implementation Fidelity in School-Based Program Evaluations

Qualitative research methods have been utilized to study the nature of work in the HIV services field. Yet current literature lacks a Highly Active Anti-Retroviral Treatment (HAART) era compendium of qualitative research studying challenges and coping strategies in the field. This study systematically reviewed challenges and coping strategies that qualitative researchers observed in the HIV services field during the HAART era, and their recommendations to organizations. Four online databases were searched for peer-reviewed research that utilized qualitative methods, were published from January 1998 to February 2012, utilized samples of individuals in the HIV services field; occurred in the U.S. or Canada, and contained information related to challenges and/or coping strategies. Abstracts were identified (n=846) and independently read and coded for inclusion by at least two of the four first authors. Identified articles (n=26) were independently read by at least two of the four first authors who r...

Challenges, coping strategies, and recommendations related to the HIV services field in the HAART era: a systematic literature review of qualitative studies from the United States and Canada.

HIV prevention counseling linked with testing has been shown to reduce high–risk behaviors and new sexually transmitted diseases in public clinic settings. However, few studies have been conducted evaluating the implementation of such models outside a research setting. This study sought to determine the extent to which the introduction of a standard protocol based on Project RESPECT improves the achievement of HIV prevention counseling goals of existing counseling and testing programs. Four prevention counseling programs contracting with the Texas Department of State Health Services completed a standardized 5–day training and implemented the protocols, counseling tools, and quality assurance (QA) procedures developed for the project. Introduction of the protocol was accomplished with existing program resources and significantly improved prevention counseling. Direct observation of counseling sessions demonstrated a significant improvement in attainment for eight of the nine counseling goals of initial ses...

Adaptation and Implementation of an Evidence–Based Prevention Counseling Intervention in Texas

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Adaptation and Implementation of an Evidence–Based Prevention Counseling Intervention in Texas