A modified theoretical framework to assess implementation fidelity of adaptive public health interventions

Abstract

BackgroundOne of the major debates in implementation research turns around fidelity and adaptation. Fidelity is the degree to which an intervention is implemented as intended by its developers. It is meant to ensure that the intervention maintains its intended effects. Adaptation is the process of implementers or users bringing changes to the original design of an intervention. Depending on the nature of the modifications brought, adaptation could either be potentially positive or could carry the risk of threatening the theoretical basis of the intervention, resulting in a negative effect on expected outcomes. Adaptive interventions are those for which adaptation is allowed or even encouraged. Classical fidelity dimensions and conceptual frameworks do not address the issue of how to adapt an intervention while still maintaining its effectiveness.DiscussionWe support the idea that fidelity and adaptation co-exist and that adaptations can impact either positively or negatively on the intervention’s effectiveness. For adaptive interventions, research should answer the question how an adequate fidelity-adaptation balance can be reached. One way to address this issue is by looking systematically at the aspects of an intervention that are being adapted. We conducted fidelity research on the implementation of an empowerment strategy for dengue prevention in Cuba. In view of the adaptive nature of the strategy, we anticipated that the classical fidelity dimensions would be of limited use for assessing adaptations. The typology we used in the assessment—implemented, not-implemented, modified, or added components of the strategy—also had limitations. It did not allow us to answer the question which of the modifications introduced in the strategy contributed to or distracted from outcomes. We confronted our empirical research with existing literature on fidelity, and as a result, considered that the framework for implementation fidelity proposed by Carroll et al. in 2007 could potentially meet our concerns. We propose modifications to the framework to assess both fidelity and adaptation.SummaryThe modified Carroll et al.’s framework we propose may permit a comprehensive assessment of the implementation fidelity-adaptation balance required when implementing adaptive interventions, but more empirical research is needed to validate it.

Containment measures for emerging and re-emerging vector-borne and other infectious diseases of poverty in urban settings: a scoping review

“…The recipient population was not well described in most studies, with only eight articles providing information on its epidemiologic and/or sociodemographic characteristics [21, 24, 27, 34, 37, 40, 41, 47], and four articles mentioned cognitive, social, and/or educational characteristics of the study population [17, 21, 35, 41]. The eight studies that evaluated the intervention’s financial, geographic, and/or sociocultural accessibility rated it as favourable [20, 24, 28, 30, 35, 37, 38, 41], although none of the studies described how these evaluations were made and are likely based on subjective opinion and information.…”

“…This tool was used to document the rationale, materials, procedures (how, by whom, when and where intervention took place), modifications, and fidelity of the intervention [17] (see Additional file 3 for the complete extraction grid used for this review).…”

Bringing research to the bedside: Knowledge translation in the mental health care of burns patients

“…However, adaptability of translational strategies is recognized as central to ‘real‐world’ application of evidence, especially in contexts where end‐user empowerment is central to achieving meaningful and sustainable behaviour change (Perez et al . ). Processes for identifying essential components for the success of an intervention and those which can be adapted without threatening the intervention integrity remain unclear (Carroll et al .…”

“…In terms of implementation design, the ‘fidelity‐adaptation balance’ (Perez et al . , p. 7) continues to challenge translational efforts. Maintaining high fidelity to intervention designs has been identified as essential to intervention effectiveness (Rychetnik et al .…”

Text Messages Sent to Household Tuberculosis Contacts in Kampala, Uganda: Process Evaluation (Preprint)

“…Fidelity evaluations seek to understand the degree to which interventions are delivered as actually intended in order to explain why they do or do not work and how they can be adapted to fit the local context [14,15]. Fidelity studies may measure the dose, frequency, and quality of interventions as actually delivered; assess participant responses to interventions; and characterize the mechanisms through which interventions work to improve outcomes [16].…”