Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA, San Francisco, CA, USA.
Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA, San Francisco, CA, USA.
Transl Behav Med. 2021 Feb 11;11(1):34-45. doi: 10.1093/tbm/ibz158.
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.
高质量地实施基于证据的干预措施对于项目的有效性很重要，并且受到培训和质量保证（QA）的影响。然而，文献中的差距导致实践环境中缺乏关于培训和监督的指导，特别是在项目发生重大调整时。我们研究了培训和 QA 与提供广泛传播的 HIV 咨询和检测 EBI 的组织之间的关系，这些组织由于新的检测技术而发生了重大调整。使用最大变异案例研究方法，我们研究了在具有高保真度和低保真度的组织中（机构：3 = 高；3 = 低）实施该计划的培训和 QA。我们确定了区分高保真度和低保真度机构的主题。例如，高保真度机构更倾向于采用团队方法进行培训；展示了使用有效 QA 策略；利用培训和 QA 来识别和调整适应性问题，包括与调整相关的挑战；并了解 RESPECT 和其他测试计划之间的区别。QA 与保真度之间的关联是强烈而直接的，而培训与保真度之间的关系则更为复杂。公共卫生需要高质量的培训和 QA 方法，以解决项目适应性和项目调整问题。研究结果强化了使用有效 QA 策略的价值。未来的工作应该通过培训和 QA 来解决提高项目适应性的方法，确定一组可以最大限度提高项目保真度且可行的 QA 策略，并确定低成本的补充培训选项。
