What counts as a core intervention component? Developing the Core-FAST (Fidelity and Adaptation for Scaling up Tool)...

Area of Science:

• Implementation Science
• Public Health Interventions
• Health Services Research

Background:

• Scaling up evidence-based interventions requires balancing fidelity with adaptation for equity.
• Identifying core intervention components is crucial before adaptation, but existing frameworks lack clarity on how to do this.
• A novel tool was needed to support the identification of core components during intervention scale-up.

Purpose of the Study:

• To co-design a practical tool, Core-FAST (Fidelity and Adaptation for Scaling up Tool), to identify core components of interventions.
• To facilitate the distinction between non-negotiable intervention elements and those open to adaptation for equitable scale-up.
• To enhance existing fidelity/adaptation frameworks for real-world application in cancer care.

Main Methods:

• A sequential, exploratory, multi-phase qualitative study involving consumers, clinicians, and researchers.
• Literature review followed by online workshops and inductive content analysis.
• Iterative development and review of the Core-FAST tool based on participant feedback.

Main Results:

• Eight key themes emerged: implementation context, active ingredients, patient safety, regulatory compliance, organizational alignment, infrastructure compatibility, equity, and acceptability.
• A draft version of Core-FAST was developed and refined.
• The final Core-FAST tool consists of seven questions to guide the identification of core versus adaptable intervention components.

Conclusions:

• Core-FAST offers a proactive method to identify essential and adaptable intervention components for equitable scale-up.
• Further research is needed to evaluate Core-FAST's effectiveness in enabling adaptation and its impact on intervention outcomes.
• Investigating the feasibility and developing a digital version of Core-FAST for practical use is recommended.