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Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation
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Balancing fidelity and adaptation: implementing evidence-based chronic disease prevention programs.

Michelle L Carvalho1, Sally Honeycutt, Cam Escoffery

  • 1Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA. mlcarva@emory.edu

Journal of Public Health Management and Practice : JPHMP
|March 7, 2013
PubMed
Summary

Community-based organizations (CBOs) adapted evidence-based chronic disease programs by changing materials, audience, and delivery to improve engagement and fit. Adaptations are natural, aiding dissemination while balancing fidelity.

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Area of Science:

  • Public Health
  • Community Health Interventions
  • Chronic Disease Prevention

Background:

  • Evidence-based interventions (EBIs) are crucial for chronic disease prevention.
  • Community-based organizations (CBOs) are key implementers of these programs.
  • Adaptations to EBIs by CBOs can impact program effectiveness and reach.

Purpose of the Study:

  • To document adaptations made by CBOs to EBIs for chronic disease prevention.
  • To identify the underlying reasons driving these program modifications.
  • To explore the balance between adaptation and fidelity in community settings.

Main Methods:

  • A process evaluation was conducted in 12 rural CBOs in southwest Georgia.
  • Data were collected through project reports, interviews, and focus groups with organizational staff.
  • Focus included program implementation, context, adaptations, and reasons for changes.

Main Results:

  • Five types of adaptations were observed: modifying educational materials, audience, delivery, adding activities, or deleting core elements.
  • Reasons for adaptation included enhancing engagement, reaching specific audiences, and increasing program fit.
  • Program deletions often resulted from 'turbulence' like staff transitions and time constraints.

Conclusions:

  • Program adaptation is an inherent aspect of implementing EBIs in community settings.
  • Understanding adaptation drivers is vital for effective dissemination strategies.
  • Balancing adaptation for relevance with fidelity is key to successful EBI implementation.