Program Integrity in Primary and Early Secondary Prevention: Are Implementation Effects Out of Control?

Dane, Andrew V.; Schneider, Barry H.

doi:10.1016/s0272-7358(97)00043-3

Cited by 1,251 publications

(1,437 citation statements)

References 45 publications

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“…In this context, research on the translation of HIV/STI behavioral prevention programs to real-world settings is critical to our understanding of how to successfully sustain program effectiveness. One tenet of translation research is that maintaining program fidelity is essential to sustaining program effectiveness [4]. There are many threats to program fidelity, including the programmatic consequences of organizational adaptations to intra-and extraagency strains (e.g., financial loss, staff turnover) (see refs.…”

Section: Overviewmentioning

confidence: 99%

“…There are many threats to program fidelity, including the programmatic consequences of organizational adaptations to intra-and extraagency strains (e.g., financial loss, staff turnover) (see refs. [4,5]). With regard to HIV/STI behavioral prevention programs, prior work has examined adaptations occurring during the early phase of the translation process (see below), but less attention has been paid to challenges to sustainability.…”

Section: Overviewmentioning

confidence: 99%

“…In general, some program modifications or adaptations are expected and may be beneficial [18][19][20]. However, eliminating or substantially changing core program components (essential elements in producing behavior change) and program structures (e.g., session length, session order, delivery method) may diminish program efficacy [4,5,21].…”

Section: Program Fidelitymentioning

confidence: 99%

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

Catania

Dolcini

Gandelman

et al. 2014

Behav. Med. Pract. Policy Res.

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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.

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Section: Overviewmentioning

confidence: 99%

Section: Overviewmentioning

confidence: 99%

Section: Program Fidelitymentioning

confidence: 99%

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

Catania

Dolcini

Gandelman

et al. 2014

Behav. Med. Pract. Policy Res.

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“…Complex behavioral interventions implemented with higher fidelity are associated with better clinical outcomes [1,2]. While several obesity interventions have proven to be efficacious in ideal study settings, the effects are often weakened when implemented in clinical settings [3], at least in part because these interventions are delivered with low fidelity.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of the ASPIRE-VA coaching fidelity checklist (ACFC): a tool to help ensure delivery of high-quality weight management interventions

Damschroder

Goodrich

Kim

et al. 2015

Behav. Med. Pract. Policy Res.

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Practical and valid instruments are needed to assess fidelity of coaching for weight loss. The purpose of this study was to develop and validate the ASPIRE Coaching Fidelity Checklist (ACFC). Classical test theory guided ACFC development. Principal component analyses were used to determine item groupings. Psychometric properties, internal consistency, and inter-rater reliability were evaluated for each subscale. Criterion validity was tested by predicting weight loss as a function of coaching fidelity. The final 19-item ACFC consists of two domains (session process and session structure) and five subscales (sets goals and monitor progress, assess and personalize self-regulatory content, manages the session, creates a supportive and empathetic climate, and stays on track). Four of five subscales showed high internal consistency (Cronbach alphas>0.70) for group-based coaching; only two of five subscales had high internal reliability for phone-based coaching. All five sub-scales were positively and significantly associated with weight loss for group-but not for phone-based coaching. The ACFC is a reliable and valid instrument that can be used to assess fidelity and guide skill-building for weight management interventionists.

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“…In such settings, differences in early and continued training, support for the implementers, and differences in the aptitude of the implementers can lead to variation in implementation. The intervention implementers, who are typically not under the control of the research team the way they are in efficacy trials, are likely to deliver the program with varied fidelity, more adaptation, and less regularity than that which occurs in efficacy trials (Dane and Schneider, 1998;Domitrovich and Greenberg, 2000;Harachi et al, 1999). Traditional intent-to-treat analyses which do not adjust for potential variations in implementation, fidelity, participation, or adherence, are often supplemented with "as-treated" analyses, mediation analysis, and other post-assignment analyses described elsewhere (Brown and Liao, 1999;Jo, 2002;MacKinnon, 2006).…”

Section: Introductionmentioning

confidence: 99%

Methods for testing theory and evaluating impact in randomized field trials: Intent-to-treat analyses for integrating the perspectives of person, place, and time

Brown¹,

Wang²,

Kellam³

et al. 2008

Drug and Alcohol Dependence

152

139

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Randomized field trials provide unique opportunities to examine the effectiveness of an intervention in real world settings and to test and extend both theory of etiology and theory of intervention. These trials are designed not only to test for overall intervention impact but also to examine how impact varies as a function of individual level characteristics, context, and across time. Examination of such variation in impact requires analytical methods that take into account the trial's multiple nested structure and the evolving changes in outcomes over time. The models that we describe here merge multilevel modeling with growth modeling, allowing for variation in impact to be represented through discrete mixtures-growth mixture models-and nonparametric smooth functions-generalized additive mixed models. These methods are part of an emerging class of multilevel growth mixture models, and we illustrate these with models that examine overall impact and variation in impact. In this paper, we define intent-to-treat analyses in group-randomized multilevel field trials and discuss appropriate ways to identify, examine, and test for variation in impact without inflating the Type I error rate. We describe how to make causal inferences more robust to misspecification of covariates * Corresponding author. Tel.: +1 813 974 6672. E-mail address: hbrown@health.usf.edu (C.H. Brown). Conflict of InterestAuthor Muthén is a co-developer of Mplus, which is discussed in this paper. There are no conflicts of interest. in such analyses and how to summarize and present these interactive intervention effects clearly. Practical strategies for reducing model complexity, checking model fit, and handling missing data are discussed using six randomized field trials to show how these methods may be used across trials randomized at different levels. NIH Public Access

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Program Integrity in Primary and Early Secondary Prevention: Are Implementation Effects Out of Control?

Cited by 1,251 publications

References 45 publications

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

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

Development and validation of the ASPIRE-VA coaching fidelity checklist (ACFC): a tool to help ensure delivery of high-quality weight management interventions

Methods for testing theory and evaluating impact in randomized field trials: Intent-to-treat analyses for integrating the perspectives of person, place, and time

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