Abstract
BackgroundAssessing the fidelity of an implementation strategy is important to understand why and how the strategy influences the uptake of evidence-based interventions. The present study aims to assess the fidelity of the two procedures for engaging primary care (PC) professionals and for the deployment of an implementation strategy for optimizing type 2 diabetes prevention in routine PC within the PREDIAPS randomized cluster implementation trial.MethodWe conducted a mixed-method fidelity evaluation study of the PVS-PREDIAPS implementation strategy. Nine PC centers from the Basque Health Service (Osakidetza) were allocated to two different procedures to engage physicians and nurses and deploy a implementation strategy to model and adapt the clinical intervention and its implementation to their specific contexts: a Global procedure, promoting the cooperation of all healthcare professionals from the beginning; or a Sequential procedure, centered first on nurses who then pursued the pragmatic cooperation of physicians. Process indicators of the delivery and receipt of implementation strategy actions, documented modifications to the planned implementation strategy, and a structured group interview with centers’ leaders were all used to assess the following components of fidelity: adherence, dose, quality of delivery, professionals’ responsiveness and program differentiation.ResultsGenerally, the procedures compared for professionals engagement and deployment of the implementation strategy were carried out with the planned differentiation. Nonetheless, some unexpected between-group differences were observed, the initial rate of collaboration of nurses being higher in the Sequential (93%) than in the Global (67%) groups. Exposure rate to the programed implementation actions (% of hours received out of those delivered) were similar in both groups by professional category, with nurses (86%) having a higher rate of exposure than physicians (75%). Professionals identified half of the planned discrete strategies and their rating of strategies’ perceived usefulness was overwhelmingly positive, with few differences between Sequential and Global centers.ConclusionsThe PVS-PREDIAPS implementation strategy has been implemented with high fidelity and minor unplanned reactive modifications. Professionals’ exposure to the implementation strategy was high in both groups. The centers’ organizational context (i.e., work overload) led to small mismatches between groups in participation and exposure of professionals to implementation actions.Trial registrationClinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017.
Highlights
Assessing the fidelity of an implementation strategy is important to understand why and how the strategy influences the uptake of evidence-based interventions
The PVS-PREDIAPS implementation strategy has been implemented with high fidelity and minor unplanned reactive modifications
The aim of the present study is to evaluate the fidelity of two procedures being compared for deploying the PVS-PREDIAPS implementation strategy to optimize type-2 diabetes prevention in primary care (PC) [15]
Summary
Assessing the fidelity of an implementation strategy is important to understand why and how the strategy influences the uptake of evidence-based interventions. Evaluating the degree to which implementation strategies are operated as designed within implementation trials are key in order to determine the internal and external validity of implementation studies [1, 3,4,5] They are necessary to investigate both the receipt and the scope of an implementation strategy to improve the adoption of evidence-based practice in routine settings [4, 7]. They help in the interpretation of outcome results of interventions translated to real practice and inform the optimization of both the clinical intervention and/or implementation strategy to favor adoption of the intervention and implementation and future scale-up in other contexts and settings [8,9,10,11]. Fidelity evaluation is especially necessary in multisite trials, where the “same” implementation strategy may be enacted and received in different ways [12, 13]
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