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Fidelity, not adaptation, is essential for implementation.

Dean L Fixsen1

  • 1Active Implementation Research Network, Inc., Albuquerque, NM, United States.

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Ensuring fidelity, or adherence to essential components, is crucial for evidence-based innovations to achieve desired outcomes. Current practices often adapt innovations, hindering reliable assessment and evidence of effectiveness.

Keywords:
essential componentsfidelityimplementationscalingscience

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Area of Science:

  • Implementation Science
  • Health Services Research

Background:

  • Evidence-based innovations are often adapted rather than implemented with fidelity.
  • Lack of fidelity assessment hinders understanding of innovation effectiveness and outcome realization.

Purpose of the Study:

  • To emphasize the critical role of fidelity in the development and implementation of evidence-based innovations.
  • To advocate for establishing and assessing essential components of innovations to ensure promised outcomes.

Main Methods:

  • Fidelity is defined as an assessment of the presence and strength of essential innovation components.
  • A key test for fidelity assessments is a high correlation (0.70+) with study outcomes.
  • Implementation is the planned process of putting an innovation into effect.

Main Results:

  • High fidelity scores indicate that essential innovation components are present, predicting positive outcomes.
  • Fidelity assessment provides evidence of an innovation's implementation.
  • A strong functional relationship between fidelity and outcomes validates the innovation's essential components.

Conclusions:

  • Fidelity assessment is essential for verifying the implementation of evidence-based innovations and achieving intended outcomes.
  • Current fidelity assessments are often inadequate, limiting evidence for the presence and effectiveness of innovations.
  • Future research and practice must prioritize robust fidelity measurement to ensure innovation success.