Hasson Henna, Hedberg Rundgren Emma, Strehlenert Helena, Gärdegård Anna, Uvhagen Håkan, Klinga Charlotte, Hedberg Rundgren Åsa, von Thiele Schwarz Ulrica
Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden.
Implement Res Pract. 2023 Jul 30;4:26334895231189198. doi: 10.1177/26334895231189198. eCollection 2023 Jan-Dec.
Evidence-based interventions (EBIs) seldom fit seamlessly into a setting and are often adapted. The literature identifies practitioners' management of fidelity and adaptations as problematic but offers little guidance. This study aimed to investigate practitioners' perceptions of the feasibility and usability of an intervention aimed to support them in fidelity and adaptation management when working with EBIs.
The intervention, the adaptation and fidelity tool (A-FiT), was developed based on the literature, along with input from social service practitioners and social services' Research and Development units' personnel. The intervention consisted of two workshops where the participants were guided through a five-step process to manage fidelity and adaptations. It was tested in a longitudinal mixed-method intervention study with 103 practitioners from 19 social service units in Stockholm, Sweden. A multimethod data collection was employed, which included interviews at follow-up, questionnaires at baseline and follow-up (readiness for change and self-rated knowledge), workshop evaluation questionnaires (usability and feasibility) after each workshop, and documentation (participants' notes on worksheets). To analyze the data, qualitative content analysis, Kruskal-Wallis tests, and Wilcoxon rank-sum tests were performed.
Overall, the practitioners had a positive perception of the intervention and perceived it as relevant for fidelity and adaptation management (mean ratings over 7.0 on usability and feasibility). The workshops also provided new knowledge and skills to manage fidelity and adaptations. Furthermore, the intervention provided insights into the practitioners' understanding about adaptation and fidelity through a more reflective approach.
Practical tools are needed to guide professionals not only to adhere to intervention core elements but also to help them to manage fidelity and adaptation. The proposed A-FiT intervention for practitioners' management of both fidelity and adaptation is a novel contribution to the implementation literature. Potentially, the next step is an evaluation of the intervention's impact in an experimental design.
基于证据的干预措施（EBIs）很少能无缝融入某种环境，通常需要进行调整。文献指出，从业者对干预保真度和调整的管理存在问题，但提供的指导很少。本研究旨在调查从业者对一种干预措施的可行性和可用性的看法，该干预措施旨在在他们运用EBIs时支持他们进行保真度和调整管理。
基于文献以及社会服务从业者和社会服务研发单位人员的意见，开发了适应与保真度工具（A-FiT）这一干预措施。该干预措施包括两个工作坊，指导参与者通过一个五步流程来管理保真度和调整。在一项纵向混合方法干预研究中对其进行了测试，研究对象是来自瑞典斯德哥尔摩19个社会服务单位的103名从业者。采用了多方法数据收集，包括随访时的访谈、基线和随访时的问卷（改变的准备情况和自我评定的知识）、每个工作坊后的工作坊评估问卷（可用性和可行性）以及文档记录（参与者在工作表上的笔记）。为了分析数据，进行了定性内容分析、Kruskal-Wallis检验和Wilcoxon秩和检验。
总体而言，从业者对该干预措施持积极看法，并认为它与保真度和调整管理相关（可用性和可行性的平均评分超过7.0）。工作坊还提供了管理保真度和调整的新知识和技能。此外，该干预措施通过一种更具反思性的方法，深入了解了从业者对调整和保真度的理解。
需要实用工具来指导专业人员不仅要坚持干预的核心要素，还要帮助他们管理保真度和调整。所提出的用于从业者管理保真度和调整的A-FiT干预措施是对实施文献的一项新贡献。下一步可能是在实验设计中评估该干预措施的影响。
