Zetterlund Johanna, Hasson Henna, von Thiele Schwarz Ulrica, Neher Margit, Wahlström Emmie
Department of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Implement Res Pract. 2025 Apr 13;6:26334895251334552. doi: 10.1177/26334895251334552. eCollection 2025 Jan-Dec.
Implementing evidence-based interventions (EBIs) in practice requires balancing fidelity and adaptation to suit new contexts. Careful considerations are needed to maintain the core elements for effectiveness while ensuring fit with new contexts. The Adaptation and Fidelity Tool (A-FiT) intervention addresses this challenge by providing support for professionals using EBIs in the sustainment phase of implementation. This study evaluates the A-FiT intervention and examines how professionals delivering an EBI manage fidelity and adaptation during the sustainment phase of implementation, before and after the intervention. Method Short, structured interviews were repeatedly conducted with 14 professionals delivering an EBI ( = 127). Data was analyzed using deductive content analysis focusing on adaptation types, planning, intentionality, and fidelity consistency. The adaptations were counted and compared before versus after the A-FiT intervention using a chi-test.
The professionals made about the same number of adaptations before and after the A-FiT intervention. However, after the intervention, significant changes in the type and intentionality of the adaptations were observed. Changes in type consisted of fewer "removing," "substituting," and "integrating another framework" adaptations and more "loosening structure" and "departing from the intervention" adaptations. Regarding intentionality, fewer planned adaptations with the intention of improving the EBI effects were made, while adaptations made for practical reasons, both planned and unplanned, increased after the A-FiT intervention. No statistical change was found regarding fidelity consistency.
The findings indicate increased awareness about fidelity and adaptation among the group leaders, resulting in fewer planned adaptations to enhance program effects and more practical adaptations to address context challenges. The A-FiT intervention appears to help professionals in their management of fidelity and adaptations when delivering EBIs. The study underscores the importance of understanding adaptations in their context, purpose, and impact (intended and unintended) on the outcome/value.
在实践中实施循证干预措施（EBI）需要在保真度和适应性之间取得平衡，以适应新的环境。需要仔细考虑以保持有效性的核心要素，同时确保与新环境相契合。适应与保真度工具（A-FiT）干预措施通过在实施的维持阶段为使用EBI的专业人员提供支持来应对这一挑战。本研究评估了A-FiT干预措施，并考察了在干预前后，实施EBI的专业人员在实施的维持阶段如何管理保真度和适应性。方法 对14名实施EBI的专业人员（n = 127）反复进行简短的结构化访谈。使用演绎性内容分析法对数据进行分析，重点关注适应类型、规划、意图和保真度一致性。使用卡方检验对A-FiT干预前后的适应情况进行计数和比较。
在A-FiT干预前后，专业人员进行的适应次数大致相同。然而，干预后，适应的类型和意图发生了显著变化。类型上的变化包括“去除”“替代”和“整合另一个框架”的适应减少，而“放宽结构”和“背离干预”的适应增加。在意图方面，为改善EBI效果而进行的计划内适应减少，而出于实际原因（包括计划内和计划外）进行的适应在A-FiT干预后增加。在保真度一致性方面未发现统计学变化。
研究结果表明，组长对保真度和适应性的认识有所提高，导致为增强项目效果而进行的计划内适应减少，而为应对环境挑战而进行的实际适应增加。A-FiT干预措施似乎有助于专业人员在实施EBI时管理保真度和适应性。该研究强调了在其背景、目的以及对结果/价值的影响（预期和非预期）方面理解适应的重要性。
