Department of Human Development & Community Health, Montana State University, Bozeman, MT 59717, USA.
Department of Family Life & Human Development, Southern Utah University, Cedar City, UT 84720, USA.
Int J Environ Res Public Health. 2023 Oct 28;20(21):6989. doi: 10.3390/ijerph20216989.
Treatment fidelity remains underreported in health intervention research, particularly among Indigenous communities. One explanation for this gap is the lack of culturally consonant strategies listed in the National Institutes of Health (NIH) Behavior Change Consortium (BCC) treatment fidelity framework, the gold standard for understanding and measuring fidelity. This paper focuses on the development and implementation of a culturally consonant treatment fidelity support plan across two of the five BCC fidelity areas, provider training and treatment delivery, within a chronic illness self-management program for the Apsáalooke (Crow) Nation. Our team selected and adapted strategies from, and added strategies to, the BCC framework, that centered on relational accountability and the Apsáalooke culture. To be culturally consonant, we approached treatment fidelity as supporting Aakbaabaaniilea (Apsáalooke program facilitators) rather than monitoring them. This resulted in the development of a fifth treatment fidelity area: building and fostering relationships. We propose that fidelity to relational accountability is the foundation of successful programs in Indigenous communities. This suggests an important shift from tracking what was conducted in an intervention to prioritizing how things were conducted. We encourage others to view the BCC framework as a starting point in developing fidelity strategies that are consonant with local cultures.
在健康干预研究中，治疗保真度的报告仍然很少，特别是在原住民社区中。造成这种差距的一个原因是缺乏美国国立卫生研究院（NIH）行为改变联盟（BCC）治疗保真度框架中列出的文化上一致的策略，该框架是理解和衡量保真度的黄金标准。本文专注于在慢性病自我管理计划中针对 Apsáalooke（Crow）民族的两个 BCC 保真度领域（提供者培训和治疗提供）制定和实施文化一致的治疗保真度支持计划。我们的团队从 BCC 框架中选择并改编了策略，并添加了以关系问责制和 Apsáalooke 文化为中心的策略。为了保持文化一致性，我们将治疗保真度视为支持 Aakbaabaaniilea（Apsáalooke 计划协调员），而不是对他们进行监督。这导致了第五个治疗保真度领域的发展：建立和培养关系。我们提出，对关系问责制的保真度是在原住民社区中成功实施计划的基础。这表明从跟踪干预措施中的内容转变为优先考虑如何进行干预措施。我们鼓励其他人将 BCC 框架视为制定与当地文化一致的保真度策略的起点。
