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From protocol to practice: Enhancing fidelity, supporting adaptation, and advancing science.

¹NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, PA, United States.

Translational Behavioral Medicine

|December 19, 2025

Summary

Balancing intervention fidelity and adaptation is key for successful evidence-based interventions (EBIs). Measuring and reporting these elements improves implementation and scalability across diverse settings.

Keywords:

adaptation evidence translation fidelity implementation fidelity implementation research modification

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Area of Science:

Implementation Science
Health Services Research

Background:

Translating evidence-based interventions (EBIs) into practice requires balancing fidelity (delivering as intended) with adaptation to local contexts.
Rigid adherence to EBIs can compromise effectiveness, while excessive adaptation may dilute intended outcomes.

Purpose of the Study:

To explore the significance and challenges of measuring and reporting intervention fidelity and adaptation.
To highlight the impact of fidelity and adaptation on the success and scalability of EBIs.

Main Methods:

Utilized implementation science frameworks and the Transitional Care Model (TCM) as a case study.
Focused on the dynamic interplay between intervention fidelity, adaptation, and contextual factors.
Emphasized practical tool development, bidirectional learning, and setting fidelity standards for intervention protocols.

Main Results:

Fidelity and adaptation are critical, yet often challenging to measure and report effectively.
Contextual factors significantly influence the balance between fidelity and adaptation.
Practical tools and clear standards are needed to guide implementation.

Conclusions:

Recommendations include enhancing training, standardizing reporting practices, and fostering collaboration.
Improved approaches will support equitable and effective implementation of EBIs in varied settings.
Addressing fidelity and adaptation is crucial for maximizing the impact of health interventions.