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

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Abstract
Background: One 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. Discussion: We 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. Summary: The 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.
Keywords
DENGUE VECTOR CONTROL, DRUG-ABUSE PREVENTION, AEDES-AEGYPTI, COMMUNITY, PARTICIPATION, COMPLEX INTERVENTIONS, CONCEPTUAL-FRAMEWORK, FUTURE-DIRECTIONS, CENTRAL VIETNAM, SOCIAL CARE, PROGRAMS, Implementation, Fidelity, Adaptation, Reinvention, Adaptive, interventions, Conceptual framework, Translating research, Cuba

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Citation

Please use this url to cite or link to this publication:

MLA
Pérez Chacón, Dennis et al. “A Modified Theoretical Framework to Assess Implementation Fidelity of Adaptive Public Health Interventions.” IMPLEMENTATION SCIENCE 11 (2016): n. pag. Print.
APA
Pérez Chacón, D., Van Der Stuyft, P., Zabala, M. del C., Castro, M., & Lefevre, P. (2016). A modified theoretical framework to assess implementation fidelity of adaptive public health interventions. IMPLEMENTATION SCIENCE, 11.
Chicago author-date
Pérez Chacón, Dennis, Patrick Van Der Stuyft, Maria del Carmen Zabala, Marta Castro, and Pierre Lefevre. 2016. “A Modified Theoretical Framework to Assess Implementation Fidelity of Adaptive Public Health Interventions.” Implementation Science 11.
Chicago author-date (all authors)
Pérez Chacón, Dennis, Patrick Van Der Stuyft, Maria del Carmen Zabala, Marta Castro, and Pierre Lefevre. 2016. “A Modified Theoretical Framework to Assess Implementation Fidelity of Adaptive Public Health Interventions.” Implementation Science 11.
Vancouver
1.
Pérez Chacón D, Van Der Stuyft P, Zabala M del C, Castro M, Lefevre P. A modified theoretical framework to assess implementation fidelity of adaptive public health interventions. IMPLEMENTATION SCIENCE. 2016;11.
IEEE
[1]
D. Pérez Chacón, P. Van Der Stuyft, M. del C. Zabala, M. Castro, and P. Lefevre, “A modified theoretical framework to assess implementation fidelity of adaptive public health interventions,” IMPLEMENTATION SCIENCE, vol. 11, 2016.
@article{8510979,
  abstract     = {Background: One 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. 
Discussion: We 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. 
Summary: The 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.},
  articleno    = {91},
  author       = {Pérez Chacón, Dennis and Van Der Stuyft, Patrick and Zabala, Maria del Carmen and Castro, Marta and Lefevre, Pierre},
  issn         = {1748-5908},
  journal      = {IMPLEMENTATION SCIENCE},
  keywords     = {DENGUE VECTOR CONTROL,DRUG-ABUSE PREVENTION,AEDES-AEGYPTI,COMMUNITY,PARTICIPATION,COMPLEX INTERVENTIONS,CONCEPTUAL-FRAMEWORK,FUTURE-DIRECTIONS,CENTRAL VIETNAM,SOCIAL CARE,PROGRAMS,Implementation,Fidelity,Adaptation,Reinvention,Adaptive,interventions,Conceptual framework,Translating research,Cuba},
  language     = {eng},
  pages        = {11},
  title        = {A modified theoretical framework to assess implementation fidelity of adaptive public health interventions},
  url          = {http://dx.doi.org/10.1186/s13012-016-0457-8},
  volume       = {11},
  year         = {2016},
}

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