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- Pettersson, Kristoffer, et al.
(författare)
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Fidelity-consistency and deliberateness of modifications in parenting programs
- 2024
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Ingår i: Implementation Science Communications. - : BioMed Central Ltd. - 2662-2211. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Evidence-based interventions (EBIs) are frequently modified in practice. It is recommended that decisions to modify EBIs should be made deliberately to ensure fidelity-consistency, yet the relationship between fidelity-consistency and deliberateness is not well understood. This study aims to explore modifications in a sample of practitioners delivering evidence-based parenting programs (i.e., interventions to strengthen parent–child relationships, reduce harmful interactions, and improve child health and well-being). The study investigated three research questions: (1) What kind of modifications are made during the delivery of parenting programs? (2) To what degree are the identified modifications consistent with the core functions of each program? and (3) Is deliberateness associated with the fidelity-consistency of the identified modifications? Methods: In total, 28 group leaders of five widely disseminated parenting programs in Sweden participated in five focus groups, and two participants from each group also participated in individual interviews (n = 10). A content analysis approach was used where the identification of modifications was directed by the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and then assessed for fidelity-consistency and four levels of deliberateness (universal, situational, conditional, and unintentional). Chi-square tests were performed to compare consistent and inconsistent modifications, and logistic regression was performed to explore whether deliberateness predicted consistency. Results: A total of 137 content modifications were identified, covering most of the content modification categories in FRAME. The most common were tailoring/tweaking/refining, adding elements, shortening/condensing, lengthening/extending, and integrating another treatment. Modifications were mostly fidelity-consistent but consistency varied greatly among categories. Furthermore, modifications made unintentionally or situationally were more likely to be fidelity-inconsistent. Conclusions: These results indicate that explicit consideration of modifications and their impact could be essential for sustaining the fidelity-consistent use of EBIs, even as such interventions are continuously modified.
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| 3. |
- von Thiele Schwarz, Ulrica, 1975-, et al.
(författare)
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Understanding the value of adhering to or adapting evidence-based interventions : a study protocol of a discrete choice experiment
- 2021
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Ingår i: Implementation Science Communications. - : Springer Science and Business Media LLC. - 2662-2211. ; 2:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Whereas the value of an evidence-based intervention (EBI) is often determined by its effect on clinicaloutcomes, the value of implementing and using EBIs in practice is broader, reflecting qualities such asappropriateness, equity, costs, and impact. Reconciling these value conflicts involves a complicated decision processthat has received very limited scholarly attention. Inspired by studies on decision-making, the objective of thisproject is to explore how practitioners appraise the values of different outcomes and to test how this appraisalinfluences their decisions surrounding the so-called fidelity–adaptation dilemma. This dilemma is related to thebalance between using an EBI as it was designed (to ensure its effectiveness) and making appropriate adaptations(to ensure alignment with constraints and possibilities in the local context).Methods: This project consists of three sub-studies. The participants will be professionals leading evidence-basedparental programs in Sweden and, in Sub-study 1, parents and decision-makers. Sub-study 1 will use sequentialfocus groups and individual interviews to explore parameters that influence fidelity and adaptation decisions—thedilemmas encountered, available options, how outcomes are valued by practitioners as well as other stakeholders,and value trade-offs. Sub-study 2 is a discrete choice experiment that will test how value appraisals influencedecision-making using data from Sub-study 1 as input. Sub-study 3 uses a mixed-method design, with findingsfrom the two preceding sub-studies as input in focus group interviews to investigate how practitioners make senseof findings from optimal decision situations (experiment) and constrained, real-world decision situations.Discussion: The project will offer unique insights into decision-making processes that influence how EBIs are usedin practice. Such knowledge is needed for a more granular understanding of how practitioners manage thefidelity–adaptation dilemma and thus, ultimately, how the value of EBI implementation can be optimized. Thisstudy contributes to our knowledge of what happens once EBIs are adopted—that is, the gap between the way inwhich EBIs are intended to be used and the way in which they are used in practice.
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