Keeping the Faith While Keeping It Real: Practical, Empirical Approaches to Evaluating Treatment Fidelity

Abstract

Practical approaches towards fidelity measurement are critical for large-scale uptake of evidence-based practices (EBPs). This descriptive review summarizes approaches to evaluation of EBP fidelity that are empirically tested and implemented in “real-world” settings. The systematic literature search covered a 30-year period (1988–2018) and included published papers describing treatment fidelity strategies for psychosocial interventions. Characterization of articles included “scientific-empirical,” “practical-empirical,” or “practical non-empirical.” Articles characterized as “practical-empirical” were the focus of the review. Twenty-five articles met inclusion criteria for “practical empirical.” These articles were coded for fidelity data collection methods, the source of fidelity information, who arbitrates or determines fidelity, if the approach is at the practice or program level, if the approach is for a specific EBP or is generic, and if fidelity is measured at the individual practitioner versus team level. The type of empirical evidence provided and the extensiveness of fidelity domains assessed was characterized for each study. Results indicated a wide variety of fidelity measurement approaches. Most commonly, outside experts assessed treatment fidelity. Half of the approaches examined fidelity at the practice level and half at the broader program level. A similar ratio examined fidelity at the individual practitioner level compared with the team level. Most approaches were specific to particular interventions. The vast majority focus on the adherence subdomain of fidelity. To date, there is no single predominant approach to fidelity assessment in real-world settings.