Fiscal loss and program fidelity: impact of the economic downturn on HIV/STI prevention program fidelity

Abstract

The economic downturn of 2007 created significant fiscal losses for public and private agencies conducting behavioral prevention. Such macro-economic changes may influence program implementation and sustainability. We examined how public and private agencies conducting RESPECT, a brief HIV/STI (sexually transmitted infection) counseling and testing intervention, adapted to fiscal loss and how these adaptations impacted program fidelity. We collected qualitative and quantitative data in a national sample of 15 agencies experiencing fiscal loss. Using qualitative analyses, we examined how program fidelity varied with different types of adaptations. Agencies reported three levels of adaptation: agency-level, program-level, and direct fiscal remedies. Private agencies tended to use direct fiscal remedies, which were associated with higher fidelity. Some agency-level adaptations contributed to reductions in procedural fit, leading to negative staff morale and decreased confidence in program effectiveness, which in turn, contributed to poor fidelity. Findings describe a "work stress pathway" that links program fiscal losses to poor staff morale and low program fidelity.

The dynamic influence of human resources on evidence-based intervention sustainability and population outcomes: an agent-based modeling approach

“…We used published statistics from the original RESPECT randomized-control trial [ 25 , 26 ] and CDC publications characterizing standard program structure and protocols [ 28 ] to inform overall model design. We also used data from two RESPECT implementation studies to inform the characterization of human resources and acquire data on RESPECT clients, staff, and agencies [ 29 – 32 ]. Specific variables, descriptions, values, and empirical data sources for each variable used to inform simulation runs are provided in Table 1 .…”

Bridging barriers to clinic-based HIV testing with new technology: translating self-implemented testing for African American youth

“…Although the present study does not directly assess program fidelity, our findings do suggest that there may be challenges with the OraQuick training component that may pose difficulties for some consumers in attainting high implementation fidelity. Program fidelity [42] here means that consumers will perform all procedures and recommendations competently enough to • "faint line could be confusing-bring more attention to the faint line in the instructions" • "Youth don't understand-they may not understand that there's a chance the test could be wrong. They may trust the test so much that they don't seek confirmatory care."…”

“…Program fit is consistently identified as important to successful program implementation [47] and represents a potential point of intervention in efforts to increase program fidelity. Although a number of HIV prevention studies have shown that poor program-client fit by agencyimplemented programs results in low program fidelity [42,[48][49][50][51][52][53], none of this work has examined selfimplemented programs.…”

Implementing a brief evidence-based HIV intervention: a mixed methods examination of compliance fidelity

“…Although we constructed a purposive sample of agencies from all regions of the USA, data are based on convenience samples of agencies and of clients, and findings may not generalize. Our measure of fidelity also has limitations [also see 37]. We were unable to assess counseling strategies that clients may not recognize (e.g., teachable moment), nor did we assess quality of delivery (i.e., competence fidelity).…”