Understanding the art and science of implementation in the SAAF efficacy trial

The purpose of this paper is to demonstrate the importance of considering both fidelity and adaptation in assessing the implementation of evidence-based programs.

The current study employs a multi-method strategy to understand two dimensions of implementation (fidelity and adaptation) in the Strong African American Families (SAAF) program. Data were video recordings of program delivery and pre-test and post-test interviews from the efficacy trial. Multilevel regression in Mplus was used to assess the impact of fidelity to the manual, coded by independent observers, on racial socialization outcomes. One activity on racial socialization, a core component of the program, was selected for an in-depth examination using conversation analysis (a qualitative method of analyzing talk in interactions).

Results of the quantitative analyses demonstrated that fidelity of the selected activity was associated with increases in parent's use of racial socialization from pre-test to post-test, but only when participant attendance was included in the model. Results of the qualitative analyses demonstrated that facilitators were making adaptations to the session and that these adaptations appeared to be in line with cultural competence.

The development of quantitative fidelity measures can be problematic, with many decision points to consider. The current study contributes to the evidence base to develop a quantitative measure of adaptation for family-based parenting programs.

Many researchers examining implementation of evidence-based programs consider fidelity and adaptation to be polar ends of a single spectrum. This paper provides evidence for the importance of examining each independently.