Implementation fidelity of an Integrated Healthy Lifestyle Service: a process evaluation

Area of Science:

• Public Health
• Health Services Research
• Implementation Science

Background:

• Integrated Healthy Lifestyle Services (IHLS) aim to improve population health outcomes.
• Evaluating the fidelity of such integrated services is crucial for understanding their effectiveness.
• Implementation fidelity ensures a service is delivered as intended, impacting its success.

Purpose of the Study:

• To evaluate the implementation fidelity of an Integrated Healthy Lifestyle Service (IHLS).
• To identify strengths and weaknesses in the IHLS implementation process.
• To inform future improvements in service design and delivery.

Main Methods:

• A pragmatic approach using 28 individual interviews and 11 focus groups.
• Involved 81 participants: key stakeholders, intervention staff (management, team leads, practitioners), and clients.
• Data were collected across five fidelity domains: study design, training, delivery, receipt, and enactment.

Main Results:

• Mixed implementation fidelity was observed across the five domains.
• High intervention receipt was reported by clients, staff, and stakeholders.
• Practitioners reported insufficient training, low confidence, and low morale due to a top-down approach.

Conclusions:

• Findings highlight a need to enhance practitioner training and support within the IHLS.
• Improving communication and operational support can boost staff confidence and morale.
• Results offer insights for refining IHLS design, delivery, and recruitment for better outcomes.