What matters when exploring fidelity when using health IT to reduce disparities?

Area of Science:

• Implementation Science
• Health Equity
• Digital Health Interventions

Background:

• Evidence-based interventions require strategies to engage diverse populations while maintaining external validity.
• Health IT tools for patient-centered messages can conflict with tailoring needs and linguistic equity.

Purpose of the Study:

• To evaluate the fidelity and acceptability of the bilingual STAR MAMA Program.
• To explore fidelity to core and modifiable equity components, including language variation.

Main Methods:

• Conducted a fidelity and acceptability evaluation of the STAR MAMA Program (bilingual intervention for postpartum women with gestational diabetes).
• Utilized an adapted implementation fidelity framework to assess core and modifiable equity components.
• Collected data from participant surveys, systems databases, and coaching notes.

Main Results:

• High intervention completion (90%) and acceptability were observed among 181 participants (96.6% Latina, 80.9% foreign-born).
• Initial systems errors were resolved; Spanish speakers had slightly more triggers but not statistically significant.
• Spanish speakers reported higher satisfaction with content (p<0.01), while English speakers found coaches less considerate of time (p=0.03).

Conclusions:

• Language-specific factors influenced fidelity and acceptability, with early systems errors remedied and high overall engagement.
• Practice implications include establishing language-equity criteria, planning for systems errors, and examining outcomes of language-concordant interventions.