Implementation fidelity is the degree to which an intervention is delivered as intended and is critical to successful translation of evidence-based interventions into practice. Diminished fidelity may be why interventions that work well in highly controlled trials may fail to yield the same outcomes when applied in real life contexts. The purpose of this paper is to define implementation fidelity and describe its importance for the larger science of implementation, discuss data collection methods and current efforts in measuring implementation fidelity in community-based prevention interventions, and present future research directions for measuring implementation fidelity that will advance implementation science.

Findings from this review indicate that the use of technology and digital delivery is a growing and emerging method of delivering parent training interventions with high potential for increasing reach and sustainability as we implement interventions in real world settings. Gaps in the studies reviewed highlight the need for consistency of dose calculations using digital methods, more research related to efficacy and comparative effectiveness studies of delivery methods.

Background Establishing the feasibility and validity of implementation fidelity monitoring strategies is an important methodological step in implementing evidence-based interventions on a large scale. Objectives The objective of the study was to examine the reliability and validity of the Fidelity Checklist, a measure designed to assess group leader adherence and competence delivering a parent training intervention (the Chicago Parent Program) in child care centers serving low-income families. Method The sample included 9 parent groups (12 group sessions each), 12 group leaders, and 103 parents. Independent raters reviewed 106 audiotaped parent group sessions and coded group leaders’ fidelity on the Adherence and Competence Scales of the Fidelity Checklist. Group leaders completed self-report adherence checklists and a measure of parent engagement in the intervention. Parents completed measures of consumer satisfaction and child behavior. Results High interrater agreement (Adherence Scale = 94%, Competence Scale = 85%) and adequate intraclass correlation coefficients (Adherence Scale = .69, Competence Scale = .91) were achieved for the Fidelity Checklist. Group leader adherence changed over time, but competence remained stable. Agreement between group leader self-report and independent ratings on the Adherence Scale was 85%; disagreements were more frequently due to positive bias in group leader self-report. Positive correlations were found between group leader adherence and parent attendance and engagement in the intervention and between group leader competence and parent satisfaction. Although child behavior problems improved, improvements were not related to fidelity. Discussion The results suggest that the Fidelity Checklist is a feasible, reliable, and valid measure of group leader implementation fidelity in a group-based parenting intervention. Future research will be focused on testing the Fidelity Checklist with diverse and larger samples and generalizing to other group-based interventions using a similar intervention model.

Data were merged from two prevention randomized trials testing 1-year outcomes of a parenting skills program, the Chicago Parent Program (CPP), and comparing its effects for African-American (n=291) versus Latino (n=213) parents and their preschool children. Compared to controls, intervention parents had improved self-efficacy, used less corporal punishment and more consistent discipline, and demonstrated more positive parenting. Intervention children had greater reductions in behavior problems based on parent-report, teacher-report, and observation. Although improvements from CPP were evident for parents in both racial/ethnic groups, Latino parents reported greater improvements in their children’s behavior and in parenting self-efficacy but exhibited greater decreases in praise. Findings support the efficacy of the CPP for African American and Latino parents and young children from low-income urban communities.

BackgroundParent training programs are traditionally delivered in face-to-face formats and require trained facilitators and weekly parent attendance. Implementing face-to-face sessions is challenging in busy primary care settings and many barriers exist for parents to attend these sessions. Tablet-based delivery of parent training offers an alternative to face-to-face delivery to make parent training programs easier to deliver in primary care settings and more convenient and accessible to parents. We adapted the group-based Chicago Parent Program (CPP) to be delivered as a self-administered, tablet-based program called the ez Parentprogram.ObjectiveThe purpose of this study was to (1) assess the feasibility of the ez Parentprogram by examining parent satisfaction with the program and the percent of modules completed, (2) test the efficacy of the ez Parentprogram by examining the effects compared with a control condition for improving parenting and child behavior in a sample of low-income ethnic minority parents of young children recruited from a primary care setting, and (3) compare program completion and efficacy with prior studies of the group-based CPP.MethodsThe study used a two-group randomized controlled trial (RCT) design with repeated measures follow up. Subjects (n=79) were randomly assigned to an intervention or attention control condition. Data collection was at baseline and 12 and 24 weeks post baseline. Parents were recruited from a large, urban, primary care pediatric clinic. ez Parentmodule completion was calculated as the percentage of the six modules completed by the intervention group parents. Attendance in the group-based CPP was calculated as the percentage of attendance at sessions 1 through 10. Satisfaction data were summarized using item frequencies. Parent and child data were analyzed using a repeated measures analysis of variance (RM-ANOVA) with simple contrasts to determine if there were significant intervention effects on the outcome measures. Effect sizes for between group comparisons were calculated for all outcome variables and compared with CPP group based archival data.Results ez Parentmodule completion rate was 85.4% (34.2/40; 95% confidence interval [CI] = 78.4%-93.7%) and was significantly greater ( P<.05) than face-to-face CPP group attendance (135.2/267, 50.6%) attendance of sessions; 95% CI = 46.8%-55.6%). ez Parentparticipants reported the program as very helpful (35/40, 88.0%) and they would highly recommend the program (33/40, 82.1%) to another parent. ez Parentparticipants showed greater improvements in parenting warmth (F1,77 = 4.82, P<.05) from time 1 to 3. No other significant differences were found. Cohen’s d effect sizes for intervention group improvements in parenting warmth, use of corporal punishment, follow through, parenting stress, and intensity of child behavior problems were comparable or greater than those of the group-based CPP.ConclusionsData from this study indicate the feasibility and acceptability of the ez Parentprogram in a low-income, ethnic minority...

We tested the cost-effectiveness of giving low-income parents childcare discounts contingent on their participation in the Chicago Parent Program, a 12-session preventive parent training (PT) program offered at their child’s daycare center. Eight centers were matched and randomized to an experimental condition in which parents received a discount on their childcare bill (M = $8.92 per session attended) or a control group with no financial incentive. Participants (n = 174) consisted mostly of African American (55%) or Latino (42%) mothers, 62% reporting annual household incomes less than $20,000. Parents in the discount condition were 15.4% more likely to enroll than control parents, though this difference was not significant. There were no differences in PT attendance, parents’ motivations for enrolling, or the degree to which parents were actively engaged in PT sessions by condition. Despite the added cost of the discounts, there was no difference in group costs by condition. Parent interviews revealed important challenges in implementing financial incentive programs in community-based agencies serving low-income families. Cost simulations show how low parent enrollment or low attendance negatively affect the economic efficiency of group-based PT. Implications for policies guiding financial incentive programs targeting low-income families and their participation in prevention programs are discussed.

Mobile health (mHealth) interventions use mobile technology (tablets and smartphones) delivery platforms for interventions to improve health outcomes. Despite growing acceptance, there is little understanding of how consumers engage with and adhere to mHealth interventions. This study analyzes usage data from the intervention arm ( n = 42) of a randomized clinical trial testing the efficacy of the ezPARENT program and provides recommendations for using engagement and adherence metrics. Engagement was measured by parent usage (duration, frequency, and activity) of ezPARENT and adherence using an adherence index (the sum of individual modules completed, number of visits to ezPARENT, and maximum time between visits). Parents spent M = 37.15 min per module and had M = 13.55 program visits in the 3-month intervention period. Parents visited the program over a period of M = 69.5 days and completed 82% of the modules. These data provide support that parents will use intervention programs delivered digitally; engagement and adherence metrics are useful in evaluating program uptake.

Public health nurses can work with communities to promote physical activity and safe outdoor places for exercise. In addition, they can advocate for the availability of healthy food choices in neighborhood schools. Maternal feeding practices, acculturation, and the child's environment require further research.