Systematic evaluation of implementation fidelity of complex interventions in health and social care

Abstract

BackgroundEvaluation of an implementation process and its fidelity can give insight into the 'black box' of interventions. However, a lack of standardized methods for studying fidelity and implementation process have been reported, which might be one reason for the fact that few prior studies in the field of health service research have systematically evaluated interventions' implementation processes.The aim of this project is to systematically evaluate implementation fidelity and possible factors influencing fidelity of complex interventions in health and social care.MethodsA modified version of The Conceptual Framework for Implementation Fidelity will be used as a conceptual model for the evaluation. The modification implies two additional moderating factors: context and recruitment. A systematic evaluation process was developed. Multiple case study method is used to investigate implementation of three complex health service interventions. Each case will be investigated in depth and longitudinally, using both quantitative and qualitative methods.DiscussionThis study is the first attempt to empirically test The Conceptual Framework for Implementation Fidelity. The study can highlight mechanism and factors of importance when implementing complex interventions. Especially the role of the moderating factors on implementation fidelity can be clarified.Trial RegistrationSupported Employment, SE, among people with severe mental illness -- a randomized controlled trial: NCT00960024.

Patient experiences of nurse-led telephone follow-up following treatment for colorectal cancer

“…Despite training, it is likely that the delivery of the intervention may alter outside the remit of a research study and the fidelity of the intervention has important implications for implementation (Hasson, 2010). It was not within the remit of this study to examine intervention fidelity but future studies should examine the long term delivery of TFU to ascertain what changes are made to delivery over time and how this may affect outcomes.…”

Disease prevention and health promotion programs: benefits, implementation, quality assurance and open questions—a summary of the evidence

“…The lower the work load, the higher the level of education, and the more extensive the introductory training, the higher the willingness of staff to utilize evidence-based interventions (Rabin et al 2010). Inadequately trained staff members are often recruited due to lack of the field experience or time pressure (Hasson 2010). One study found that health education instructors differ in terms of role perception, and that a knowledge transfer-and control-based role perception can weaken health promotion programs (Jourdan et al 2010).…”

Conceptual and Methodological Issues in Evaluations of Road Safety Countermeasures

“…Valid determination of causal attribution also requires information on the intervention-what was provided, to whom, in what amount, in what way [8,31]. Without a detailed process (implementation) evaluation to document whether an intervention was implemented as it was supposed to be implemented, evaluations can commit what is called in evaluation literature a Type III error-evaluation of an inadequately delivered intervention [31,32].…”

“…Without a detailed process (implementation) evaluation to document whether an intervention was implemented as it was supposed to be implemented, evaluations can commit what is called in evaluation literature a Type III error-evaluation of an inadequately delivered intervention [31,32]. Many evaluations of road safety countermeasures do not examine the "process"; that is, whether the intervention was actually delivered as per objectives.…”