Professionals’ management of the fidelity–adaptation dilemma in the use of evidence-based interventions—an intervention study

• Background: Evidence-based interventions (EBIs) can be effective tools for the prevention of disease and healthpromotion. However, their implementation often requires a delicate balance between the need to adjust theintervention to the context in which it is implemented and the need to keep the core components that make theintervention effective. This so-called dilemma between fidelity and adaptation is often handled by healthprofessionals in the sustainment phase of an implementation (i.e., once the intervention has been adopted andinstitutionalized in an organization), but not much is known about how and to what extent health professionals areaffected by this dilemma. Focusing on the sustainment phase, this project aims to study (1) how fidelity andadaptation are managed by professionals using an EBI, (2) how the fidelity–adaptation dilemma affectsprofessionals’ psychosocial working conditions, and (3) how a structured decision support influences professionals’management of the dilemma and their psychosocial working conditions.Methods: The study is set in Sweden, and the EBI in focus is a parental program (All Children in Focus). Alongitudinal within-person intervention design is used, combined with a cross-sectional survey design. Data sourcesinclude web-based questionnaires, brief interviews, fidelity ratings, paper-and-pen questionnaires, and writtendocumentation, collected at multiple time points with both group leaders and parents as respondents.Discussion: This project approaches fidelity and adaptation from the perspective of the professionals that manageEBIs during the sustainment phase of implementation. Although it is well known that EBIs continue to change overtime, it remains to be understood how the fidelity–adaptation dilemma can be managed so that the effectivenessof interventions is retained or improved, not diluted. Moreover, the project adds to the literature by presenting anoccupational health perspective on the fidelity–adaptation dilemma. It is acknowledged that fidelity and adaptationmay have consequences for not only clients but also the occupational wellbeing of the professionals managing thedilemma, and subsequently, their willingness and ability to deliver EBIs in a sustainable way.

Ämnesord

SAMHÄLLSVETENSKAP  -- Psykologi -- Psykologi (hsv//swe)

SOCIAL SCIENCES  -- Psychology -- Psychology (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Arbetsmedicin och miljömedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Occupational Health and Environmental Health (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)

Nyckelord

Professionals

Adaptation

Adherence

Fidelity–adaptation dilemma

Evidence-based interventions

Decision support

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