Professionals’ management of the fidelity–adaptation dilemma in the use of evidence-based interventions—an intervention study

Abstract

Background Evidence-based interventions (EBIs) can be effective tools for the prevention of disease and health promotion. However, their implementation often requires a delicate balance between the need to adjust the intervention to the context in which it is implemented and the need to keep the core components that make the intervention effective. This so-called dilemma between fidelity and adaptation is often handled by health professionals in the sustainment phase of an implementation (i.e., once the intervention has been adopted and institutionalized in an organization), but not much is known about how and to what extent health professionals are affected by this dilemma. Focusing on the sustainment phase, this project aims to study (1) how fidelity and adaptation are managed by professionals using an EBI, (2) how the fidelity–adaptation dilemma affects professionals’ psychosocial working conditions, and (3) how a structured decision support influences professionals’ management of the dilemma and their psychosocial working conditions. Methods The study is set in Sweden, and the EBI in focus is a parental program (All Children in Focus). A longitudinal within-person intervention design is used, combined with a cross-sectional survey design. Data sources include web-based questionnaires, brief interviews, fidelity ratings, paper-and-pen questionnaires, and written documentation, collected at multiple time points with both group leaders and parents as respondents. Discussion This project approaches fidelity and adaptation from the perspective of the professionals that manage EBIs during the sustainment phase of implementation. Although it is well known that EBIs continue to change over time, it remains to be understood how the fidelity–adaptation dilemma can be managed so that the effectiveness of interventions is retained or improved, not diluted. Moreover, the project adds to the literature by presenting an occupational health perspective on the fidelity–adaptation dilemma. It is acknowledged that fidelity and adaptation may have consequences for not only clients but also the occupational wellbeing of the professionals managing the dilemma, and subsequently, their willingness and ability to deliver EBIs in a sustainable way.

A Slippery Slope When Using an Evidence-Based Intervention Out of Context. How Professionals Perceive and Navigate the Fidelity-Adaptation Dilemma—A Qualitative Study

“…Together, this indicates that there is a need for support for the professionals, focusing both on guiding navigation and ensuring quality care. The design and evaluation of such support, aiming to help professionals with decision-making regarding fidelity and adaptations when implementing an EBI, is currently underway (44,45).…”

Engaging stakeholders to inform national implementation of critical time intervention in a program serving homeless-experienced Veterans

“…These efforts can enable greater fidelity and sustainment, as well as effectiveness, in larger implementation initiatives. Though the implementation of EBPs requires a careful balance between tailoring interventions to contexts and maintaining fidelity to an EBP's core components (Von Thiele Schwarz et al, 2021 ; Wiltsey Stirman, 2022 ), we highlight the value of pilot work that tailors and enhances EBP training, technical assistance, and implementation supports to reflect relevant contextual factors.…”

Enhancing the Irish National Audit of Dementia: An adaptation study

“…[23]) and adaptation (e.g. [11,18,24]) have been described as a process to increase fit with context. Tailoring refers to, "interventions planned following an investigation into the factors that explain current professional practice and any reasons for resisting new practice."…”