Implementation Fidelity Research Articles

ABSTRACT The purpose of this study was twofold: (a) to describe the process of implementing an intervention program that included two-stage e-learning coaching practices and (b) to evaluate the participants’ procedural fidelity levels. The participants were a preschool teacher and a mother of a child diagnosed with Autism Spectrum Disorder (ASD). The case study method, one of the qualitative research methods, was applied to describe the process, and the A-B single-subject research design was used to evaluate the mother’s practices. The teacher’s fidelity of implementation was 97%. In the baseline phase, the mother’s implementation performance was at 4.3% and after the implementation of the program, her correct responding percentages were 70%, 90%, 98%, and 99%, respectively. In accordance with the purpose of the study, the process is described in detail for researchers and practitioners who want to run similar applications. The findings reveal that the teacher and the mother acquired the targeted skills through the two-stage coaching practice. Given that the study included only one participant, the findings cannot be generalized; the results, however, suggest that the implemented program was effective based on the observed procedural fidelity and participant outcomes.

There is an increasing need to measure caregiver implementation of strategies from Naturalistic Developmental Behavioral Interventions (NDBIs) as a possible key mediator of outcomes in a child. The NDBI Fidelity (NDBI-Fi) rating scheme is a macro-code to estimate the implementation of core strategies. Yet, there is a need to understand the dependability of this measure to ensure intervention study findings are generalizable to everyday interactions and comparable across studies. We addressed this by evaluating the dependability or consistency of NDBI-Fi scores for 20 caregivers, averaged across observations of two occasions of two routines that were each scored by two raters. Our findings indicated that a single score (i.e. from a single occasion, single routine, and single rater) from the measure has low dependability (g = 0.43). When scores were averaged across two observations each of two routines scored by two raters (i.e. eight scores total), the score was more dependable (g = 0.77). The majority (81.6%) of absolute error variance was attributable to occasions of observation and its interaction with other facets (routine or rater). Therefore, we recommend the NDBI-Fi be applied to more than one observation of more than one routine to strengthen confidence that scores are generalizable to everyday parent-child interactions.Lay abstractOutcomes from caregiver-mediated interventions typically include measuring the caregiver's use of key techniques. The Naturalistic Developmental Behavioral Intervention-Fidelity (NDBI-Fi) tool is a valid measurement strategy for estimating caregiver use. In this study, we sought to understand how to improve data collection from natural observations of caregivers with their children to ensure the scores are representative of how the caregiver and child typically interact. We observed 20 caregiver-child pairs via telehealth in snack and play routines over two different days. Each video was rated using the NDBI-Fi by two observers. We learned that increasing the number of observations may be the best way to improve the dependability of scores from natural caregiver-child observations. This study adds to recent research seeking to understand how to best measure caregiver strategy use. These findings may guide future researchers and clinicians to consider increasing the number of observations used to evaluate caregiver use of intervention techniques in research studies or clinical practice.

Many early childhood educators (ECEs) feel inadequately prepared to teach students with or at risk for disabilities and report challenges in implementing evidence-based practices (EBP) with fidelity. e Coaching through online Bug-In-Ear (BIE) technology is an EBP that can be used to enhance educators’ implementation fidelity of EBP by providing immediate, ongoing feedback in real time. In this paper, the application of an e Coaching mentor model (eCMM) as a means to enhance ECEs’ use of EBP with fidelity in the classroom is presented. Practical guidance on integrating the e CMM in a professional development (PD) framework, including recommendations for equipment, setup procedures, and step-by-step instructions and video resources is also described. A vignette is included to illustrate a practical application of the e CMM.

BackgroundAutism and ADHD are heritable, co-occurrent, and associated with difficulties with executive functioning (cognitive and self-regulation skills which enable us to set and work toward goals). Executive function difficulties, and their negative impacts across cognitive, health and social domains, extend to individuals with first-degree relatives who are autistic or have ADHD, even if they do not meet thresholds for a clinical diagnosis themselves. Supporting executive function development in children with elevated autism traits, or a first-degree relative with autism or ADHD, addresses community priorities for early support to help achieve the best mental health, education and life outcomes.MethodsThis study will evaluate the feasibility and acceptability of a randomized controlled trial (RCT) of a parent-toddler programme entitled “Supporting Toddlers with a connection to autism or ADHD to develop strong Attention, Regulation and Thinking skills” (START). START is a neurodiversity-affirming programme, co-refined through extensive Patient and Public Involvement. Sixty parent-child dyads, in Oxford or Southampton (UK), will be randomized using Sealed Envelope by a researcher not involved in recruitment, delivery or outcome data collection to receive START or usual practice, on a 1:1 ratio. Children (20 months old) will be assessed using questionnaires completed by the parent (not blind to allocation) post-intervention (within 2 weeks of the end of the active intervention wave, when children are aged 27–31 months), and using parent questionnaires and a battery of executive function measures administered by researchers blind to allocation at baseline and follow-up (36 months old). START will be delivered in small groups to 30 parent-child dyads, in community settings.DiscussionWe will assess the feasibility of recruiting eligible participants to the study, the reliability of measures of implementation fidelity and degree of implementation fidelity achieved, the appropriateness of proposed outcome and mechanism measures, the acceptability of an RCT of the programme, parental adherence to the programme, logistics of programme delivery, and the acceptability of START, using mixed-method measures of engagement and satisfaction. Results will inform the design and implementation of a definitive RCT of START, and yield broader insights into the delivery and evaluation of complex early-years interventions in community settings.Trial registrationISRCTN registry ISRCTN99820028 https://doi.org/10.1186/ISRCTN99820028.

This meta-analysis systematically examined the effects of differentiated instruction (DI) on English language proficiency, addressing the growing need for instructional approaches that address diverse student profiles․ Seven empirical studies published between 2017 and 2024 were included. The overall pooled mean difference was 2․92 with a 95% confidence interval [1․64–4․19], indicating significant improvements in learners' grammar, reading comprehension, and fluency․ A high heterogeneity level (I² = 87%) was observed․ The findings support DI as an effective pedagogical approach in multilingual English classrooms, consistently demonstrating its positive impact on grammar, reading comprehension, fluency, and overall language achievement compared to traditional approaches․ However, substantial variability in effect sizes highlighted the influence of educational contexts, student characteristics, and DI implementation strategies․ Methodological concerns, particularly regarding randomization and allocation concealment, also limited internal validity and generalizability․ Despite these limitations, the findings reinforce DI’s potential to promote equitable learning and enhance student engagement, advocating for its broader application in multilingual settings․ Future research should adopt more rigorous experimental designs, longitudinal approaches, and comprehensive evaluations of implementation fidelity, while exploring contextual factors that shape DI effectiveness, to refine both theoretical frameworks and practical guidelines․

Late-stage breast cancer contributes to a growing number of deaths in sub-Saharan Africa (SSA) but few studies examine scalable early detection strategies. Following small-scale pilots, in 2020 Rwanda launched an adapted Women's Cancer Early Detection Programme (WCEDP), integrating clinical breast exam (CBE) for symptomatic patients with cervical cancer screening. A WCEDP-specific electronic health record (EHR) was developed to facilitate patient tracking. We used the RE-AIM implementation science framework to retrospectively evaluate implementation of breast cancer early detection within the WCEDP over 12 months in the first three scale-up districts (population: 2 009 888), using routinely-collected electronic and paper data from 15 health centres and 3 hospitals. We examined the WCEDP's Reach in the target population, Effectiveness linking patients to care, Adoption by facilities and fidelity to the Implementation protocol. Regarding Reach, average weekly health centre visits for CBE increased from 18 to 33 post-WCEDP launch; of 1688 women receiving CBE through the WCEDP, 12.0% were ≥50 years. Regarding effectiveness, among 383 women referred to district or referral hospitals, 157 (40.9%) had no documented referral facility visit. Of those seen at a referral facility, median days from health centre to district hospital visit and from district to referral hospital visit were 6 (IQR 1.8-14.8) and 8 (IQR 5.0-40.5) respectively. Among the 36 patients receiving biopsy, 72.2% were biopsied within 60 days of initial presentation. In terms of adoption, 79 clinicians were trained in cancer early detection, with 69.6% remaining at WCEDP facilities after 3 years. Regarding implementation fidelity, WCEDP clinics were held 52.6% of weeks. EHR data quality was inconsistent, with half of patients seen at district hospitals for breast care lacking EHR documentation. Breast cancer early detection services can be implemented in resource-constrained SSA health facilities. Integration with cervical cancer screening may be a promising strategy. However, investing in data systems is critical to support programme evaluation and high-quality care.

Abstract The RECETAS project aims to test the Friends in Nature (FIN) intervention in 6 different countries and target populations through 3 pre-post studies (France, Ecuador and Australia) and 3 randomized controlled trials (Finland, Spain and Czech Republic). Given that FIN is a complex intervention implemented and adapted in 6 different socio-economic and cultural contexts, process evaluation is a key element shared by the six studies. This presentation aims to report and discuss how implementation fidelity was structured and the results obtained across sites. A fidelity checklist was created jointly by all involved partners to capture the key components of the intervention. Quantitative data on the degree of implementation of each component were collected at group level for each group undergoing FIN. The checklist comprised the individual components of FIN (interview and empowerment letter), group structure (group size, number of sessions and number of facilitators) and group process in terms of mentoring (in-site visits and learning diary) and group dynamics (empowerment and group climate, nature-based activities, dynamics on loneliness and social connection and continuation of the group). A high degree of fidelity was reported across components and sites, meaning FIN can be adapted and implemented in different contexts while maintaining its core values. Although relevant adaptations were planned before the implementation, assessing fidelity helped us to identify specific challenges that require further adaptation of procedures to certain populations.

459 Background: Quality improvement (QI) addresses local quality gaps to optimize care delivery, while implementation science (IS) seeks to increase adoption of evidence-based practices (EBPs) to close research-practice gaps and improve population health. Identifying opportunities for QI-IS synergy can foster collaboration and ensure attention to rapid and sustainable improvements in evidence-based care. Our objectives were to 1) assess how QI projects submitted for silver or gold certification in our academic medical center addressed evidence-based gaps in cancer care and 2) consider how their methods align with IS approaches. Methods: The QI project database was keyword searched to identify proposals in cancer. Data including detailed description of the quality gap and methods to identify and evaluate interventions were abstracted and entered in a database organized by the DMAIC framework (Define, Measure, Analyze, Improve, and Control). Two investigators reviewed data to identify EBPs and describe evidence using a typology for IS (Type 1 etiology and burden, Type 2 intervention effectiveness, and Type 3 dissemination and implementation in context). Data in DMAIC domains were mapped to relevant IS constructs for side-by-side comparison. Results: The search identified 81 proposals submitted between May 2017 and April 2025, of which 62 targeted cancer-related care gaps (5.2% of applications). Fourteen referenced published EBPs, including American Society for Clinical Oncology or National Comprehensive Cancer Network guidelines and state or federal quality metrics on cancer screening or evaluations for diagnosis and treatment. An additional 17 addressed processes relevant to EBPs, e.g., screening documentation. QI tools like cause-and-effect diagrams identified multilevel causes, but few proposals deployed multilevel interventions (strategies in IS), and none referenced theory. Reported “lessons learned” further detailed unanticipated patient, care team, and system-level challenges. Most (n=24, 77%) of EBP-related proposals addressed Type 2 evidence (e.g., performance, quality, efficiency) but could have also been framed as Type 3 evidence on implementation context/strategies targeting implementation outcomes (e.g., clinician adoption, patient reach, implementation fidelity). Conclusions: Although focused on local improvement, about 1 in every 20 QI proposals addressed implementation of cancer EBPs. Framing QI purpose as addressing Type 3 evidence could help link local QI projects to IS theory and methods to inform strategy selection and evaluation of implementation outcomes that precede service-level outcomes. Organizations that combine rapid-cycle QI improvements and rigorous IS methodologies may more effectively close care gaps and tackle persistent healthcare challenges.

Implementation Fidelity of a Smartphone Application for Population-Based General Movement Assessment: The Early Moves Study.

Medical safety huddles are short, structured meetings for physicians to proactively discuss and respond to profession-specific patient safety concerns, with the goal of decreasing future adverse events. Prior observational studies found associations with improved patient safety outcomes, but no randomised controlled studies have been conducted. The primary objective was to determine the impact of medical safety huddles on adverse events. Secondary objectives included the fidelity of huddle implementation and the impact on patient safety culture among physicians. Stepped-wedge cluster randomised trial with four sequences, and each hospital site was a cluster. Inpatient oncology, surgery and rehabilitation programmes in four academic hospitals. Physicians in participating programmes. Medical safety huddles were adapted for local context and implemented sequentially based on a computer-generated random sequence every 2 months after a 4-month control period. All sites remained in the intervention phase for at least 9 months. The primary outcome was the rate of adverse events, as determined through blinded chart audits of 912 randomly selected patients. The fidelity of implementation was assessed through the huddle attendance rate, number of safety issues raised in the huddles and number of actions taken in response. Patient safety culture was assessed using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety. The adjusted rate of adverse events (per 1000 patient days) in the postintervention phase was 12% lower compared with preintervention (RR: 0.88; 95% CI: 0.80 to 0.98; p=0.016). The odds of having adverse events posthuddle implementation were 17% lower in the postintervention period compared with preintervention (OR intervention vs control: 0.83; 95% CI: 0.80 to 0.87; p<0.001). The mean huddle attendance rate at each site ranged from 30% to 85%, and the mean number of issues raised per huddle and the mean number of actions taken per huddle ranged from 1.6 to 3.1. The mean (SD) overall patient safety rating increased from 2.3 (0.53) to 2.8 (0.88), p=0.010. The mean per cent (SD) positive score for the composite measures of 'Organisational learning' increased significantly from 35% (26%) to 54% (23%), p=0.00, 'Response to error' 37% (24%) to 52% (22%), p=0.025 and 'Communication about error' 36% (28%) to 64% (42%), p=0.016 after implementation. Medical safety huddles decreased adverse events and may improve patient safety culture through engaging physicians. NCT05365516.

Peer support can enhance the rehabilitation experience for people with traumatic brain injury (TBI). Understanding the feasibility of integrating peer support using a co-design approach can ensure effective delivery. This study aimed to evaluate the feasibility of implementing a community-based peer support program for people with moderate to severe TBI using a co-designed approach. A case series pre-post feasibility study was conducted in partnership with a community brain injury organisation. Participants were adults who experienced a moderate to severe TBI <12months earlier. Feasibility was assessed using process (recruitment and retention rates), resource (adherence to intervention), management (implementation fidelity) and scientific indicators (pre-post intervention changes). Three participants were included, and most measures of feasibility were achieved. Process was achieved with a recruitment rate of 60% (3/5) and a retention rate of 100%. Resource feasibility was achieved with all peer support sessions (100%). Management feasibility was met through the completion of a co-created checklist of session management by peer support workers. Scientific feasibility outcomes showed limited change between pre- and post-intervention. This study demonstrates the feasibility of a co-designed peer support program for people with TBI. Future research may examine the implementation of peer support to explore program scalability and refine outcome measures to better capture the benefits of a peer support focused intervention.

Adolescents and youth require age-appropriate, comprehensive sexuality education and health services to support healthy growth and development. This study evaluated the coverage and fidelity of implementation of the National Standards for Adolescent- and youth-friendly Sexual and Reproductive Health (SRH) Services across types of health facilities in Tanzania. A descriptive cross-sectional study was conducted from November,1st - 30th, 2022, in eleven purposely selected health facilities across three Tanzanian regions: Dar es Salaam, Dodoma, and Kigoma. Facilities were stratified by ownership (government versus faith-based) and type (Dispensary, Health Center, Hospital). Data were collected using an observation checklist adapted from the Tanzanian Ministry of Health and analyzed with an International Business Machine (IBM®) Statistical Package for Social Sciences (SPSS™) version 26, and the findings are presented in frequencies (n) and percentages (%). Of the 11 health facilities assessed, 9(82%) were government-owned and 2(18%) fatith-based; 3(27%) were Dispensaries, 55% (n = 6) Health Centers and 18% (n = 2) Hospitals. Findings revealed that all facilities (100%) offered adolescent- and youth-friendly SRH services. However, the average implementation fidelity of the National Standards of SRH services was 65%, of which none achieved full compliance with the National Standards. Health centers, including Tandale health center (73%), Kigogo health center (71%), Ujiji health center (67%), Baptist Council Designated Hospital, and Magomeni (60%) health center had the highest coverage and fidelity implementation of the adolescent-and youth-friendly SRH national standards, while Murufiti dispensary was the lowest (43%). Nevertheless, government-owned facilities achieved the highest coverage and fidelity in implementing adolescent- and youth-friendly SRH services compared to faith-based facilities. The study revealed suboptimal coverage and incomplete implementation fidelity of National Standards for adolescent- and youth-friendly SRH services in Tanzanian health facilities. Enhancing infrastructures, strengthening healthcare worker capacity, and improving access to SRH education and associated services are critical to advancing the quality and reach of these services across the country.

ABSTRACT: Math anxiety undermines students’ participation, persistence, and achievement across ages and cultures. This paper synthesizes theory-based interventions that target both emotion and learning processes. Three frameworks organize the review: cognitive-behavioral, constructivist, and social learning. Cognitive-behavioral interventions challenge irrational beliefs, teach relaxation and cognitive restructuring, and use graded exposure to mathematics; they reliably raise test performance and often reduce anxiety. Constructivist approaches emphasize hands-on, inquiry-oriented, and collaborative problem solving, remove counterproductive time pressures, and prioritize relational understanding over rote procedures. Social learning strategies leverage peer modeling, tutoring, and supportive classroom norms to build self-efficacy. In practice, effective programs integrate these strands into multimodal designs that combine emotion regulation, conceptual scaffolds, and structured peer support. The review also summarizes assessment and evaluation. Widely used measures such as the MARS, AMAS, and MAS-UK enable screening and monitoring. Mixed-methods evaluations—pre/post-tests, growth models, interviews, and reflective writing—link anxiety reductions to gains in mathematical performance. Case studies during COVID-19 further highlight the benefits of collaborative, hands-on learning and mindfulness-based components. Implications follow for classroom practice and policy: adopt process-focused instruction, normalize help-seeking, embed brief CBT micro-lessons, expand peer supports, and fund rigorous, scalable interventions. Noted limitations include small convenience samples and uneven demographic representation; future research should pursue longitudinal, diverse, and comparative trials with transparent implementation fidelity. Overall, converging evidence shows that theoretically grounded, multimodal interventions can meaningfully reduce math anxiety while enhancing achievement when implemented with fidelity and evaluated systematically. Clear reporting standards and equitable sampling will strengthen generalizability and classroom translation worldwide adoption. Keywords: math anxiety; cognitive-behavioral therapy; constructivist learning; social learning; multimodal interventions; assessment scales; self-efficacy.

There is a lack of evidence-informed teaching approaches for autistic students, particularly in culturally diverse, low-resource settings. This study implemented a manualized, evidence-informed teaching approach called Classroom Pivotal Response Teaching (CPRT) in an urban special education school in Bengaluru, India. CPRT provides teaching strategies that addresses student motivation, initiation, and generalization during implementation of learning goals. All students in the study had diagnoses of moderate to severe autism, and some also had intellectual disability. We assessed the acceptability, feasibility, and implementation fidelity of CPRT using a mixed-methods approach. Eight special educators were trained in CPRT over ten weeks. All eight educators were successfully trained to fidelity, and six of eight teachers maintained fidelity 1.5 to 4 months after training. Further, qualitative data indicated that CPRT was considered acceptable and beneficial, particularly to student engagement, skill acquisition, and speech, as well as teachers' self-efficacy. CPRT was feasible to educators in individual teaching settings and for high-priority learning goals, as opposed to group settings for all learning goals, due to time and resource constraints.All eight educators were successfully trained to fidelity, and six of eight teachers maintained fidelity 1.5 to 4 months after training. Further, qualitative data indicated that CPRT was considered acceptable and beneficial, particularly to student engagement, skill acquisition, and speech, as well as teachers' self-efficacy. CPRT was feasible to educators in individual teaching settings and for high-priority learning goals, as opposed to group settings for all learning goals, due to time and resource constraints. Overall, this study demonstrates the promise of CPRT in special education settings in India, suggesting the need for a larger-scale efficacy trial.

Several school-based physical activity interventions have been developed to address the critical public health concern that children are not meeting the recommended daily moderate-to-vigorous physical activity (MVPA). However, less is known about implementation fidelity and its impact on programme efficacy. This study examined process evaluation findings of a school-based physical education (PE) intervention and its impact on MVPA among 3rd and 4th-grade children. Four fidelity components (adherence, dose, quality of delivery, and participant responsiveness) were assessed through weekly, unannounced direct observations of intervention classrooms. MVPA was assessed using accelerometry at baseline and post-intervention. Multilevel modelling was used to assess the effect of implementation fidelity on child MVPA. Overall fidelity score of our intervention was high (76.4%), although participant responsiveness (82.4%) and quality of delivery (77.8%) were implemented more successfully than dose (65.8%) and adherence (52%). Participant responsiveness was a statistically significant predictor of change in student MVPA (β = 26.14, 95% CI: 2.68, 49.60). Adherence, dose, quality of delivery, and overall fidelity were not significant predictors of student outcomes. Participant responsiveness is an important aspect of fidelity. School-based PE interventions should focus on enhancing student engagement for successful impact. Further investigation is needed to identify factors that enhance child responsiveness.

Identity confusion among university-age students is linked to anxiety, motivational decline, and reduced academic responsibility. In pesantren contexts, mahasantri must reconcile academic rigor with spiritual–communal norms, making culturally grounded interventions necessary. Objective: To develop and validate a counselor-ready module that uses the East Javanese folk performance Jaran Bodhag to strengthen identity clarification (discipline, resilience, simplicity, responsibility) among mahasantri at PPA Ibnu Katsir Putri, Jember. Methods: A Research &amp; Development design following ADDIE guided needs analysis, co-design, expert content validation (CVI/Aiken’s V framework), prototype refinement, and a small-scale field tryout. Participants were 25 female mahasantri selected purposively. Data sources included expert ratings, fidelity checklists, learner acceptability questionnaires, and brief reflections. Results: Expert appraisal yielded an overall validity score of 80%, classifying the product as “valid/feasible with minor revision.” The tryout showed high acceptability and contextual fit; fidelity logs indicated deliverability within regular guidance sessions. Priority revisions were to (a) sharpen the service-plan sequencing and (b) add a concise glossary. Conclusion: A culturally grounded, arts-integrated module is feasible and acceptable for addressing identity-crisis indicators among mahasantri and is ready for broader piloting. Usefulness: The product offers a practical, counselor-facing package aligned with school guidance routines, enhancing cultural resonance and implementation fidelity. Suggestions: Future studies should employ multi-expert CVI/CR procedures, report item-level indices, use validated pre–post measures with comparator groups, document implementation fidelity systematically, and examine mediators (e.g., self-efficacy) across diverse pesantren settings.

The PIDO-P (Pharmacist Intervention and Dose Optimization of Phosphate-binding medication) was designed to improve high serum phosphate concentration (SPC) in haemodialysis patients with a high pill burden of phosphate-binding medication (PBM). This intervention consisted of three pharmacist-patient consultations, in which barriers to adherence to PBM were addressed and PBM dose was reduced. Although this intervention improved PBM adherence, SPC remained high. To determine the implementation fidelity (IF) of the PIDO-P intervention. This mixed-methods implementation study had a convergent design using the intervention mixed-methods framework. Data from all patients included in the PIDO-P study (n = 75) were used to assess IF using Carroll's Framework for IF. Six key components were identified [A: identifying barriers, B: assessing medication-related health literacy; C: providing information and advice, D: discussing patient preferences, E: providing a summary/dose reduction advice, F: performing a follow-up consultation].Two researchers independently rated the extent to which the different aspects of the key intervention components were carried out as planned. Data sources were research administration (quantitative and qualitative), oral surveys from patients (quantitative and qualitative) and pharmacists (quantitative), semi-structured interviews with six patients, two pharmacists, and three prescribers (qualitative), and electronic medical records (quantitative). Data from semi-structured interviews were thematically analysed according to Braun and Clarke with Atlas.ti, quantitative data were analysed using descriptive statistics in SPSS.Where possible, data integration was performed. The adherence to the intervention was moderate to high, except for the screening process. The written summary was delivered to a moderate degree (65.3%). Facilitation strategies were helpful, and pharmacists considered the intervention not too complex. The quality of delivery and participant responsiveness were good. Four IF themes could be identified: (1) patient knowledge and understanding, (2) correct use of PBM, (3) PBM treatment individualisation, (4) relationship between pharmacist and patient. To increase its feasibility, the intervention should be targeted at patients with SPC > 2.0 mmol/L, and patient selection should be improved. The lack of effect of the PIDO-P intervention on SPC cannot be explained by low IF. Targeting patients with higher SPC and improving patient selection may increase its effectiveness.

To investigate the scalability of the multi-component Falls After Stroke Trial (FAST) intervention tailored to community-dwelling adults with stroke to enable post-trial implementation. A mixed-methods formative evaluation of FAST data guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Community settings across three states in Australia. Stroke participants were a subset of FAST trial participants (n=50) who were community-dwelling adults who had experienced a stroke up to 5 years prior and were at risk of falling. Therapists who delivered the intervention in the trial (interventionists) were physiotherapists and occupational therapists, trained in the FAST intervention. The FAST intervention is an individually tailored home safety and functional exercise programme designed to reduce falls and improve community mobility. It is offered over a 6-month period using 10 home visits, two telephone calls and programme resources, for example, manual and worksheets. Trial data, including interventionist training records and delivery data, resources and stroke participants' adherence data were used to assess the Adoption, Implementation and Maintenance dimensions of the RE-AIM framework. The FAST intervention was delivered by 22 interventionists. High implementation fidelity was shown with 90% of the stroke participants receiving FAST dose and content. Effective strategies supporting implementation included standardised programme resources, comprehensive pre-programme training, regular interventionist feedback and interventionist mentoring from experts. Online training and peer support networks will be required for scale up. This study identifies how a complex intervention to prevent falls after stroke was successfully delivered. The AIM dimensions provided insights to FAST features essential for scale-up. Interventionist training, resources and mentoring/feedback were essential for adoption within the trial. Training and resources should be accessible in an online format for scale up (maintenance). ACTRN12619001114134.

Stigma, or the negative beliefs and attitudes surrounding substance use disorders, is a complex process that acts as a barrier to expanding harm-reduction services. Communication campaigns with educational and social contact components show promise in addressing stigma but are similarly complex and require defining which existing community views to target and with what content. To this end, we leveraged a social marketing approach to integrate evidence on stigmatizing views from the community with expertise from academic researchers and product development from a marketing firm for the Connection is Hope: End Stigma campaign in Fayette County, Indiana. The resulting 6-month marketing plan included two components: social media (Facebook) and social contact (in-person networking and social events). Awareness of and information-seeking on harm-reduction activities in Fayette County and positive feedback to campaign products increased over the course of the campaign despite low implementation fidelity of the social contact component. A social marketing approach shows promise in triangulating expertise to create awareness for substance use and harm-reduction services, which can address inaccurate beliefs leading to stigma. However, triangulating expertise requires increased attention to participatory decision-making to ensure community ownership and create opportunities for positive social contact.

BackgroundAntimicrobial resistance (AMR) is driven by the inappropriate use of antibiotics. “One-size-fits-all” campaigns have demonstrated little impact in increasing public knowledge of antibiotic use and AMR. Whilst healthcare providers are the most trusted sources of health information, only half of the adult population have a healthcare encounter annually. Their limited reach suggests inadequacies in communication channels and a need for mobilization of community-based non-healthcare influencers to increase accessibility to information on antibiotic use and AMR. Whilst the engagement of community barbershops and hair salons as health advocates has been well studied and shown to be effective for health education, there is no study to date harnessing ubiquitous neighborhood food establishments for health education and none assessing the comparative effectiveness of various types of neighborhood establishments as health advocates. This study protocol describes research which aims to compare the effectiveness of health education facilitated by neighborhood food and beauty establishments, versus neighborhood clinics, in increasing the public’s knowledge of antibiotic use and AMR, and improving antibiotic behaviors.MethodsA quasi-experimental study will be conducted in highly frequented healthcare clinics, and beauty and food establishments in two neighborhoods in Central Singapore. Clients (patients/patrons) aged ≥ 21 years visiting the chosen establishments will be invited to participate in the one-year-long study by scanning the QR code on recruitment posters placed within the establishment premises. Participants will receive educational information on antibiotic use and AMR via a two-minute animated video, developed based on the knowledge needs and media preferences of the community. Outcome measures, namely participants’ knowledge of antibiotic use and AMR, and antibiotic use practices will be assessed via self-administered surveys conducted at five longitudinal time-points: pre-intervention, immediate post-intervention, 1-month post-intervention, 3-month post-intervention, and 6-month post-intervention. Additionally, the reach and implementation fidelity of the intervention at the participating study sites will be assessed.DiscussionFindings from the study will enable a more comprehensive understanding of the potential reach and effects of health education facilitated by neighborhood retail establishments in relation to neighborhood healthcare clinics, enabling better insights into selecting health message outreach options.Trial registrationClinicalTrials.gov NCT06998576; https://clinicaltrials.gov/study/NCT06998576; first posted on 2025-05-31, last update posted on 2025-06-05.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24338-z.