Implementing evidence-based programs: a four-step protocol for assuring replication with fidelity

Health care providers are challenged to replicate evidence-based programs in their communities. These programs may be adapted to fit new communities, but the key components must be delivered with fidelity. This article describes a four-step fidelity assurance protocol developed by the Hawai'i's Healthy Aging Partnership as it adapted and replicated evidence-based health promotion programs for Hawai'i's older adults. The four steps are the following: (a) deconstruct the program into its components and prepare a step-by-step plan for program replication; (b) identify agencies ready to replicate the program, and sponsor excellent training to local staff who will deliver and coordinate it; (c) monitor the fidelity of program delivery using standardized checklists; and (d) track participant outcomes to assure achievement of expected outcomes. The protocol is illustrated with examples from Hawai'i's Healthy Aging Partnership's experience replicating EnhanceFitness, a senior exercise program. This protocol is transferrable to other communities wanting to adapt and replicate evidence-based, public health programs.