Abstract

BackgroundEvidence-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.MethodsThe 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.DiscussionThis 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.

Highlights

  • Evidence-based interventions (EBIs) can be effective tools for the prevention of disease and health promotion

  • – Explores how professionals can be supported in the management of fidelity and adaptation

  • A decision support intervention, which focuses on professionals and might serve as a tool to manage the fidelity–adaptation dilemma during sustained use, is tested

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Summary

Methods

Additional data will be collected during the parent group sessions (with parents and group leaders as respondents) and the decision support workshops (with group leaders) (see Fig. 1). In line with the within-person design, the data collection will be repeated for a second group after the group leader has participated in the decision support workshops. A brief process evaluation questionnaire, including appraisals of the workshop as well as knowledge of and attitudes towards fidelity and adaptations, will be collected at four time points: before the first workshop (W0), after the first (W1) and second (W2) workshops, and at a follow-up (W3) in conjunction with the last web-based group leader questionnaire (Q2). The quantitative data will be analyzed with descriptive analyses (e.g., frequencies, correlations) and more advanced analysis, such as multilevel analysis (e.g., accounting for dependencies in parental data), and mix-methods to investigate and triangulate changes over time

Discussion
Background
Findings
Background variables of parents
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