von Thiele Schwarz Ulrica, Giannotta Fabrizia, Neher Margit, Zetterlund Johanna, Hasson Henna
School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden.
Procome, Medical Management Centre, Karolinska Institute, Stockholm, Sweden.
Implement Sci Commun. 2021 Mar 16;2(1):31. doi: 10.1186/s43058-021-00131-y.
Evidence-based interventions (EBIs) can be effective tools for the prevention of disease and health promotion. However, their implementation often requires a delicate balance between the need to adjust the intervention to the context in which it is implemented and the need to keep the core components that make the intervention effective. This so-called dilemma between fidelity and adaptation is often handled by health professionals in the sustainment phase of an implementation (i.e., once the intervention has been adopted and institutionalized in an organization), but not much is known about how and to what extent health professionals are affected by this dilemma. Focusing on the sustainment phase, this project aims to study (1) how fidelity and adaptation are managed by professionals using an EBI, (2) how the fidelity-adaptation dilemma affects professionals' psychosocial working conditions, and (3) how a structured decision support influences professionals' management of the dilemma and their psychosocial working conditions.
The study is set in Sweden, and the EBI in focus is a parental program (All Children in Focus). A longitudinal within-person intervention design is used, combined with a cross-sectional survey design. Data sources include web-based questionnaires, brief interviews, fidelity ratings, paper-and-pen questionnaires, and written documentation, collected at multiple time points with both group leaders and parents as respondents.
This project approaches fidelity and adaptation from the perspective of the professionals that manage EBIs during the sustainment phase of implementation. Although it is well known that EBIs continue to change over time, it remains to be understood how the fidelity-adaptation dilemma can be managed so that the effectiveness of interventions is retained or improved, not diluted. Moreover, the project adds to the literature by presenting an occupational health perspective on the fidelity-adaptation dilemma. It is acknowledged that fidelity and adaptation may have consequences for not only clients but also the occupational wellbeing of the professionals managing the dilemma, and subsequently, their willingness and ability to deliver EBIs in a sustainable way.
基于证据的干预措施（EBIs）可以成为预防疾病和促进健康的有效工具。然而，其实施通常需要在根据实施背景调整干预措施的需求与保留使干预措施有效的核心组成部分的需求之间达成微妙的平衡。这种所谓的保真度与适应性之间的困境，在实施的维持阶段（即干预措施已在组织中被采用并制度化之后）通常由卫生专业人员来处理，但对于卫生专业人员如何以及在多大程度上受到这一困境的影响，我们了解得并不多。本项目聚焦于维持阶段，旨在研究：（1）专业人员如何运用基于证据的干预措施来管理保真度和适应性；（2）保真度 - 适应性困境如何影响专业人员的心理社会工作条件；（3）结构化的决策支持如何影响专业人员对该困境的管理及其心理社会工作条件。
该研究在瑞典开展，所关注的基于证据的干预措施是一个家长项目（“关注所有儿童”）。采用纵向个体内干预设计，并结合横断面调查设计。数据来源包括网络问卷、简短访谈、保真度评级、纸笔问卷以及书面文件，在多个时间点收集，以小组组长和家长作为受访者。
本项目从在实施维持阶段管理基于证据的干预措施的专业人员的角度来探讨保真度和适应性。尽管众所周知基于证据的干预措施会随时间不断变化，但如何管理保真度 - 适应性困境以保持或提高干预措施的有效性而非使其减弱，仍有待了解。此外, 该项目通过呈现关于保真度 - 适应性困境的职业健康视角，为文献增添了内容。人们认识到，保真度和适应性不仅可能对客户产生影响，也可能对处理该困境专业人员的职业幸福感产生影响，进而影响他们以可持续方式提供基于证据的干预措施的意愿和能力。
