Component analysis of adherence in a family intervention

Most studies of adherence use a single global measure to examine the relation of adherence to outcomes. These studies inform us about effects of overall implementation but not about importance of specific program elements. Previous research on the Strengthening Families Program 10-14 has shown that outcomes were unrelated to global adherence. The purpose of the present study was to determine whether adherence to specific components of SFP was related to outcomes, even though global adherence was not.

The authors micro-coded data from an observational study of 11 instances of SFP (N = 47 facilitators, 151 participants) into specific process and content components. Using multilevel analysis, they examined the relation of each component to program outcomes, accounting for individual- and program-level variables.

Most associations of adherence with outcome were negligible for European-Americans but significant for minority participants.

Global assessments of implementation are insufficient for complex, multi-component prevention programs and may obscure relations of implementation to outcomes. Additionally, program components may function differently based on participant characteristics.

Facilitators would benefit from understanding the function of individual program components, particularly when programs are delivered to diverse audiences. Program developers should provide detailed logic models of program theory to guide facilitators' decisions about adaptation.

This is one of only a few studies to examine the relation of adherence to specific intervention components to outcomes in a real-world setting. Results show the utility of component analysis and the importance of considering individual characteristics for implementation assessment.