Balancing Fidelity and Adaptation

Carvalho, Michelle; Honeycutt, Sally; Escoffery, Cam; Glanz, Karen; Sabbs, Darrell; Kegler, Michelle C.

doi:10.1097/phh.0b013e31826d80eb

Cited by 90 publications

(57 citation statements)

References 20 publications

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“…An approach that gives this autonomy and responsibility to health professionals will result in a trial that does not hinder real effects from happening and therefore creates an intervention that will be more easily translated into daily practice. However, researchers should keep a continuous watch on adaptations made by health professionals, because significant changes in the programme’s core components might endanger the objectives of the trial and no longer lead to the desired outcomes [38]. In our case, the regional research coordinators ensured that the core elements of the MetSLIM intervention were implemented and noticed that too little interference can actually endanger the data collection and process of a trial.…”

Section: Discussionmentioning

confidence: 99%

A lifestyle intervention study targeting individuals with low socioeconomic status of different ethnic origins: important aspects for successful implementation

et al. 2017

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BackgroundEvaluation of the implementation process of trials is important, because the way a study is implemented modifies its outcomes. Furthermore, lessons learned during implementation can inform other researchers on factors that play a role when implementing interventions described in research. This study evaluates the implementation of the MetSLIM study, targeting individuals with low socioeconomic status of different ethnic origins. The MetSLIM study was set up to evaluate the effectiveness of a lifestyle programme on waist circumference and other cardio-metabolic risk factors. The objective of this evaluation was to identify components that were essential for the implementation of the MetSLIM study and to inform other researchers on methodological aspects when working with inadequately reached populations in health research.MethodsIn this evaluation study the experiences of health professionals, study assistants, a community worker and regional research coordinators involved in the MetSLIM study were explored using semi-structured interviews. Questionnaires were used to evaluate participants’ satisfaction with the lifestyle intervention.ResultsOur analyses show that a flexible recruitment protocol eventually leads to recruitment of sufficient participants; that trust in the recruiter is an important factor in the recruitment of individuals with low socioeconomic status of different ethnic origins; and that health professionals will unavoidably shape the form of intervention activities. Furthermore, our evaluation shows that daily practice and research mutually influence each other and that the results of an intervention are a product of this interaction.ConclusionsHealth promotion research would benefit from a perspective that sees intervention activities not as fixed entities but rather as social interaction that can take on numerous forms. Analysing and reporting the implementation process of studies, like in this evaluation, will allow readers to get a detailed view on the appropriateness of the (intended) study design and intervention for the targeted population. Evaluation studies that shed light on the reasons for adaptations, rather than describing them as deviation from the original plan, would point out methodological aspects important for a study’s replication. Furthermore, they would show how various factors can influence the implementation, and therewith initiate a learning cycle for the development of future intervention studies.Trial registrationNetherlands Trial Register NTR3721 (since November 27, 2012).

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Section: Discussionmentioning

confidence: 99%

A lifestyle intervention study targeting individuals with low socioeconomic status of different ethnic origins: important aspects for successful implementation

et al. 2017

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“…Challenges in designing and implementing cost-effective and useful public health program evaluations have been well documented [5-9]. A related Cochrane Collection review recommended the need for more good-quality studies with interventions that effectively promote adherence to dietary advice [10].…”

Section: Introductionmentioning

confidence: 99%

Purposive Facebook Recruitment Endows Cost-Effective Nutrition Education Program Evaluation

Lohse¹,

Wamboldt²

2013

JMIR Res Protoc

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BackgroundRecent legislation established a requirement for nutrition education in federal assistance programs to be evidence-based. Recruitment of low-income persons to participate and evaluate nutrition education activities can be challenging and costly. Facebook has been shown to be a cost-effective strategy to recruit this target audience to a nutrition program.ObjectiveThe purpose of our study was to examine Facebook as a strategy to recruit participants, especially Supplemental Nutrition Assistance Program Education (SNAP-Ed) eligible persons, to view and evaluate an online nutrition education program intended to be offered as having some evidence base for SNAP-Ed programming.MethodsEnglish-speaking, low-income Pennsylvania residents, 18-55 years with key profile words (eg, Supplemental Nutrition Assistance Program, Food bank), responded to a Facebook ad inviting participation in either Eating Together as a Family is Worth It (WI) or Everyone Needs Folic Acid (FA). Participants completed an online survey on food-related behaviors, viewed a nutrition education program, and completed a program evaluation. Facebook set-up functions considered were costing action, daily spending cap, and population reach.ResultsRespondents for both WI and FA evaluations were similar; the majority were white, <40 years, overweight or obese body mass index, and not eating competent. A total of 807 Facebook users clicked on the WI ad with 73 unique site visitors and 47 of them completing the program evaluation (ie, 47/807, 5.8% of clickers and 47/73, 64% of site visitors completed the evaluation). Cost per completed evaluation was US $25.48; cost per low-income completer was US $39.92. Results were similar for the FA evaluation; 795 Facebook users clicked on the ad with 110 unique site visitors, and 73 completing the evaluation (ie, 73/795, 9.2% of ad clickers and 73/110, 66% of site visitors completed the evaluation). Cost per valid completed survey with program evaluation was US $18.88; cost per low-income completer was US $27.53.ConclusionsWith Facebook we successfully recruited low-income Pennsylvanians to online nutrition program evaluations. Benefits using Facebook as a recruitment strategy included real-time recruitment management with lower costs and more efficiency compared to previous data from traditional research recruitment strategies reported in the literature. Limitations prompted by repeated survey attempts need to be addressed to optimize this recruitment strategy.

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“…The need to modify these evidence-based interventions (EBIs) when they are implemented in new practice settings is somewhere between common and universal (3–5), yet program adaptation is an area with significant unresolved issues (6,7). Among those issues are differing perspectives on the value of program changes (7,8). From one perspective, they are undesirable deviations from a tried-and-true formula that lead to a voltage drop in the intervention’s efficacy (9,10).…”

Section: Introductionmentioning

confidence: 99%

“…One step in this direction is to deepen our understanding of the ways that implementing organizations adapt EBIs in the real world (8). On the basis of our observations from a cross-site evaluation of the implementation of an EBI for pediatric asthma care coordination into 4 urban community settings, we propose the notion of “retrofitting” as a type of adaptation that may be common in practice but is not fully accounted for in existing theoretical frameworks.…”

Section: Introductionmentioning

confidence: 99%

The “Retrofitting” Approach to Adapting Evidence-Based Interventions: A Case Study of Pediatric Asthma Care Coordination, United States, 2010–2014

Janevic

2016

Prev. Chronic Dis.

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Adaptation of evidence-based interventions upon implementation into new practice settings is universal, yet poorly understood. During a cross-site evaluation of the implementation of a proven intervention for pediatric asthma care coordination into 4 resource-challenged settings, we conducted in-depth interviews with site representatives, who reported how and why they modified intervention components. Interview notes were coded for themes. We focused on a single theme from a respondent who described the adaptation process as “backing” the intervention into ongoing services; we found evidence of a similar process at other sites. We labeled this process “retrofitting” to signify adaptation that consists of altering existing services to align with intervention components, rather than modifying the intervention to fit a new setting. Advantages of retrofitting may include allowing organizations to keep what works, capitalizing on existing support for program activities, elevating the role of local knowledge, and potentially promoting the sustainability of effective innovations.

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Balancing Fidelity and Adaptation

Cited by 90 publications

References 20 publications

A lifestyle intervention study targeting individuals with low socioeconomic status of different ethnic origins: important aspects for successful implementation

A lifestyle intervention study targeting individuals with low socioeconomic status of different ethnic origins: important aspects for successful implementation

Purposive Facebook Recruitment Endows Cost-Effective Nutrition Education Program Evaluation

The “Retrofitting” Approach to Adapting Evidence-Based Interventions: A Case Study of Pediatric Asthma Care Coordination, United States, 2010–2014

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