Eisman Andria B, Kilbourne Amy M, Greene Dana, Walton Maureen, Cunningham Rebecca
Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
Prev Sci. 2020 Aug;21(6):820-829. doi: 10.1007/s11121-020-01120-8.
Intervention effects observed in efficacy trials are rarely seen when programs are broadly disseminated, underscoring the need to better understand factors influencing fidelity. The Michigan Model for Health™ (MMH) is an evidence-based health curriculum disseminated in schools throughout Michigan that is widely adopted but delivered with limited fidelity. Understanding implementation determinants and how they influence fidelity is essential to achieving desired implementation and behavioral outcomes. The study surveyed health teachers throughout Michigan (n = 171) on MMH implementation, guided by the Consolidated Framework for Implementation Research. We investigated relationships between context, intervention and provider factors and dose delivered (i.e., the proportion of curriculum delivered by teachers), a fidelity dimension. We also examined whether intervention factors were moderated by provider factors to influence fidelity. Our results indicated that program packaging ratings were associated with dose delivered (fidelity). We also found that this relationship was moderated by teacher experience. The strength of this relationship diminished with increasing levels of experience, with no relationship among the most experienced teachers. Intervention adaptability was also associated with dose delivered. We found no association between health education policies (context), provider beliefs, and dose delivered. Intervention factors are important determinants of fidelity. Our results suggest that providers with more experience may need materials tailored to their knowledge and skill level to support materials' continued usefulness and fidelity long-term. Our results also suggest that promoting adaptability may help enhance fidelity. Implementation strategies that focus on systematically adapting evidence-based health programs may be well suited to enhancing the fidelity of the MMH curriculum across levels of teacher experience.
当项目广泛传播时，疗效试验中观察到的干预效果很少出现，这突出表明需要更好地理解影响保真度的因素。密歇根健康模式™（MMH）是一种基于证据的健康课程，在密歇根州的学校中传播，被广泛采用，但实施保真度有限。了解实施决定因素及其对保真度的影响对于实现预期的实施和行为结果至关重要。本研究以实施研究综合框架为指导，对密歇根州的健康教师（n = 171）进行了MMH实施情况调查。我们调查了背景、干预和提供者因素与实施剂量（即教师实施的课程比例，这是一个保真度维度）之间的关系。我们还研究了干预因素是否会受到提供者因素的调节以影响保真度。我们的结果表明，项目包装评级与实施剂量（保真度）相关。我们还发现，这种关系受到教师经验的调节。随着经验水平的提高，这种关系的强度减弱，经验最丰富的教师之间没有关系。干预的适应性也与实施剂量相关。我们发现健康教育政策（背景）、提供者信念与实施剂量之间没有关联。干预因素是保真度的重要决定因素。我们的结果表明，经验更丰富的提供者可能需要根据他们的知识和技能水平量身定制的材料，以长期支持材料的持续有用性和保真度。我们的结果还表明，促进适应性可能有助于提高保真度。专注于系统地调整基于证据的健康项目的实施策略可能非常适合提高不同经验水平教师的MMH课程保真度。
