A qualitative analysis of the concepts of fidelity and adaptation in the implementation of an evidence-based HIV prevention intervention

Jill Owczarzak, Michelle Broaddus, Steven Pinkerton

Research output: Contribution to journalArticle

Abstract

Continued debate about the relative value of fidelity versus adaptation, and lack of clarity about the meaning of fidelity, raise concerns about how frontline service providers resolve similar issues in their daily practice. We use SISTA ('Sisters Informing Sisters on Topics about acquired immune deficiency syndrome'), an evidence-based human immunodeficiency virus (HIV) prevention intervention for African American women, to understand how facilitators and program directors interpret and enact implementation fidelity with the need for adaptation in real-world program delivery. We conducted 22 in-depth, semi-structured interviews with service providers from four agencies implementing SISTA. Facilitators valued their skills as group leaders and ability to emotionally engage participants as more critical to program effectiveness than delivering the intervention with strict fidelity. Consequently, they saw program manuals as guides rather than static texts that should never be changed and, moreover, viewed the prescriptive nature of manuals as undermining their efforts to fully engage with participants. Our findings suggest that greater consideration should be given to understanding the role of facilitators in program effectiveness over and above the question of whether they implement the program with fidelity. Moreover, training curricula should provide facilitators with transferable skills through general facilitator training rather than only program-specific or manual-specific training.

Original languageEnglish (US)
Pages (from-to)283-294
Number of pages12
JournalHealth Education Research
Volume31
Issue number2
DOIs
StatePublished - Apr 1 2016

Fingerprint

Program Evaluation
HIV
Siblings
evidence
Aptitude
African Americans
Curriculum
Acquired Immunodeficiency Syndrome
service provider
Interviews
director
leader
curriculum
lack
ability
interview
Group

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Education

Cite this

A qualitative analysis of the concepts of fidelity and adaptation in the implementation of an evidence-based HIV prevention intervention. / Owczarzak, Jill; Broaddus, Michelle; Pinkerton, Steven.

In: Health Education Research, Vol. 31, No. 2, 01.04.2016, p. 283-294.

Research output: Contribution to journalArticle

@article{d129b936c91f4a6487b8c4d3b05ab221,
title = "A qualitative analysis of the concepts of fidelity and adaptation in the implementation of an evidence-based HIV prevention intervention",
abstract = "Continued debate about the relative value of fidelity versus adaptation, and lack of clarity about the meaning of fidelity, raise concerns about how frontline service providers resolve similar issues in their daily practice. We use SISTA ('Sisters Informing Sisters on Topics about acquired immune deficiency syndrome'), an evidence-based human immunodeficiency virus (HIV) prevention intervention for African American women, to understand how facilitators and program directors interpret and enact implementation fidelity with the need for adaptation in real-world program delivery. We conducted 22 in-depth, semi-structured interviews with service providers from four agencies implementing SISTA. Facilitators valued their skills as group leaders and ability to emotionally engage participants as more critical to program effectiveness than delivering the intervention with strict fidelity. Consequently, they saw program manuals as guides rather than static texts that should never be changed and, moreover, viewed the prescriptive nature of manuals as undermining their efforts to fully engage with participants. Our findings suggest that greater consideration should be given to understanding the role of facilitators in program effectiveness over and above the question of whether they implement the program with fidelity. Moreover, training curricula should provide facilitators with transferable skills through general facilitator training rather than only program-specific or manual-specific training.",
author = "Jill Owczarzak and Michelle Broaddus and Steven Pinkerton",
year = "2016",
month = "4",
day = "1",
doi = "10.1093/her/cyw012",
language = "English (US)",
volume = "31",
pages = "283--294",
journal = "Health Education Research",
issn = "0268-1153",
publisher = "Oxford University Press",
number = "2",

}

TY - JOUR

T1 - A qualitative analysis of the concepts of fidelity and adaptation in the implementation of an evidence-based HIV prevention intervention

AU - Owczarzak, Jill

AU - Broaddus, Michelle

AU - Pinkerton, Steven

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Continued debate about the relative value of fidelity versus adaptation, and lack of clarity about the meaning of fidelity, raise concerns about how frontline service providers resolve similar issues in their daily practice. We use SISTA ('Sisters Informing Sisters on Topics about acquired immune deficiency syndrome'), an evidence-based human immunodeficiency virus (HIV) prevention intervention for African American women, to understand how facilitators and program directors interpret and enact implementation fidelity with the need for adaptation in real-world program delivery. We conducted 22 in-depth, semi-structured interviews with service providers from four agencies implementing SISTA. Facilitators valued their skills as group leaders and ability to emotionally engage participants as more critical to program effectiveness than delivering the intervention with strict fidelity. Consequently, they saw program manuals as guides rather than static texts that should never be changed and, moreover, viewed the prescriptive nature of manuals as undermining their efforts to fully engage with participants. Our findings suggest that greater consideration should be given to understanding the role of facilitators in program effectiveness over and above the question of whether they implement the program with fidelity. Moreover, training curricula should provide facilitators with transferable skills through general facilitator training rather than only program-specific or manual-specific training.

AB - Continued debate about the relative value of fidelity versus adaptation, and lack of clarity about the meaning of fidelity, raise concerns about how frontline service providers resolve similar issues in their daily practice. We use SISTA ('Sisters Informing Sisters on Topics about acquired immune deficiency syndrome'), an evidence-based human immunodeficiency virus (HIV) prevention intervention for African American women, to understand how facilitators and program directors interpret and enact implementation fidelity with the need for adaptation in real-world program delivery. We conducted 22 in-depth, semi-structured interviews with service providers from four agencies implementing SISTA. Facilitators valued their skills as group leaders and ability to emotionally engage participants as more critical to program effectiveness than delivering the intervention with strict fidelity. Consequently, they saw program manuals as guides rather than static texts that should never be changed and, moreover, viewed the prescriptive nature of manuals as undermining their efforts to fully engage with participants. Our findings suggest that greater consideration should be given to understanding the role of facilitators in program effectiveness over and above the question of whether they implement the program with fidelity. Moreover, training curricula should provide facilitators with transferable skills through general facilitator training rather than only program-specific or manual-specific training.

UR - http://www.scopus.com/inward/record.url?scp=84964350644&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84964350644&partnerID=8YFLogxK

U2 - 10.1093/her/cyw012

DO - 10.1093/her/cyw012

M3 - Article

C2 - 26944867

AN - SCOPUS:84964350644

VL - 31

SP - 283

EP - 294

JO - Health Education Research

JF - Health Education Research

SN - 0268-1153

IS - 2

ER -