Use of effective training and quality assurance strategies is associated with high-fidelity EBI implementation in practice settings: a case analysis

Abstract

High-quality implementation of evidence-based interventions is important for program effectiveness and is influenced by training and quality assurance (QA). However, gaps in the literature contribute to a lack of guidance on training and supervision in practice settings, particularly when significant adaptations in programs occur. We examine training and QA in relationship to program fidelity among organizations delivering a widely disseminated HIV counseling and testing EBI in which significant adaptations occurred due to new testing technology. Using a maximum variation case study approach, we examined training and QA in organizations delivering the program with high- and low-fidelity (agencies: 3 = high; 3 = low). We identified themes that distinguished high- and low-fidelity agencies. For example, high-fidelity agencies more often employed a team approach to training; demonstrated use of effective QA strategies; leveraged training and QA to identify and adjust for fit problems, including challenges related to adaptations; and understood the distinctions between RESPECT and other testing programs. The associations between QA and fidelity were strong and straightforward, whereas the relationship between training and fidelity was more complex. Public health needs high-quality training and QA approaches that can address program fit and program adaptations. The study findings reinforced the value of using effective QA strategies. Future work should address methods of increasing program fit through training and QA, identify a set of QA strategies that maximize program fidelity and is feasible to implement, and identify low-cost supplemental training options.

Family physicians’ preferences for education to support family caregivers: a sequential mixed methods study

“…When asked about what education might address these barriers, physicians in the interviews intimated that education could socialize family caregiver support. Education and training are recognized strategies to bolster evidence-based practices and change the culture and context of care [ 59 , 60 ]. They suggested education on the unique needs and challenges faced by caregivers and how to address caregiver concerns and incorporate caregiver support efficiently within the constraints of clinical practice.…”

Building capacity from within: qualitative evaluation of a training program aimed at upskilling healthcare workers in delivering an evidence-based implementation approach

“…Ongoing training and support are provided to the Implementation Leads individually via scheduled teleconferences conducted prior to each HaSP phase (see Appendix 2 for an example pre-phase teleconference agenda). In line with recommendations by Dolcini et al [ 12 ], the teleconferences aim to supplement the workshop training by revisiting phase-specific tasks in detail, reviewing Toolkit instructions and relevant materials, and providing tailored, site-specific guidance. Teleconferences also provide opportunities for Implementation Leads to practice new skills (e.g., explaining audit data and process maps) and obtain feedback from the research team.…”

“…Partnerships with behavioral science and implementation researchers to train and support staff from within the health system to lead evidence-based implementation approaches may be a more sustainable approach for effective translation [ 11 ], and evidence suggests that this approach can improve the fidelity of implementation program delivery [ 12 ]. These partnerships enable the complementary combination of contemporary evidence-based approaches to implementation and behavior change (including the explicit application of theory) with the tacit and contextual knowledge of end-user hospital staff [ 13 ].…”

“…For example, The Training Institute for Dissemination and Implementation Research in Health (TIDIRH) course builds capacity among researchers, healthcare professionals and health managers internationally to apply evidence-based implementation methods in the design of improvement efforts [ 24 ]. However, relatively few studies describe programs targeted to healthcare workers to address the additional need to train and support those in the healthcare system who will be tasked with delivering these programs in practice [ 12 , 24 , 25 ]. Delivering an evidence-based implementation approach may require healthcare workers to tackle unfamiliar tasks and apply new skillsets.…”

Investigating Supervision and Leadership Practices to Strengthen EBP Implementation in the Child Welfare System: A Case Study Analysis

“…High-quality supervision during implementation supports effective delivery of new EBPs (Casillas et al, 2016). Certain supervision strategies have received empirical support across a number of disciplines, including active learning strategies, such as skill demonstration, behavioral rehearsal, role play, and observation and feedback (Dolcini et al, 2021; Lyon et al, 2011). These strategies provide opportunities for supervisors to reinforce or correct behaviors for effective EBP delivery.…”