Ulrica von Thiele Schwarz1,2, Fabrizia Giannotta3, Margit Neher4,5, Johanna Zetterlund3, Henna Hasson4,6. 1. School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden. ulrica.schwarz@mdh.se. 2. Procome, Medical Management Centre, Karolinska Institute, Stockholm, Sweden. ulrica.schwarz@mdh.se. 3. School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden. 4. Procome, Medical Management Centre, Karolinska Institute, Stockholm, Sweden. 5. Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden. 6. Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, Sweden.
Abstract
BACKGROUND: Evidence-based interventions (EBIs) can be effective tools for the prevention of disease and health promotion. However, their implementation often requires a delicate balance between the need to adjust the intervention to the context in which it is implemented and the need to keep the core components that make the intervention effective. This so-called dilemma between fidelity and adaptation is often handled by health professionals in the sustainment phase of an implementation (i.e., once the intervention has been adopted and institutionalized in an organization), but not much is known about how and to what extent health professionals are affected by this dilemma. Focusing on the sustainment phase, this project aims to study (1) how fidelity and adaptation are managed by professionals using an EBI, (2) how the fidelity-adaptation dilemma affects professionals' psychosocial working conditions, and (3) how a structured decision support influences professionals' management of the dilemma and their psychosocial working conditions. METHODS: The study is set in Sweden, and the EBI in focus is a parental program (All Children in Focus). A longitudinal within-person intervention design is used, combined with a cross-sectional survey design. Data sources include web-based questionnaires, brief interviews, fidelity ratings, paper-and-pen questionnaires, and written documentation, collected at multiple time points with both group leaders and parents as respondents. DISCUSSION: This project approaches fidelity and adaptation from the perspective of the professionals that manage EBIs during the sustainment phase of implementation. Although it is well known that EBIs continue to change over time, it remains to be understood how the fidelity-adaptation dilemma can be managed so that the effectiveness of interventions is retained or improved, not diluted. Moreover, the project adds to the literature by presenting an occupational health perspective on the fidelity-adaptation dilemma. It is acknowledged that fidelity and adaptation may have consequences for not only clients but also the occupational wellbeing of the professionals managing the dilemma, and subsequently, their willingness and ability to deliver EBIs in a sustainable way.
BACKGROUND: Evidence-based interventions (EBIs) can be effective tools for the prevention of disease and health promotion. However, their implementation often requires a delicate balance between the need to adjust the intervention to the context in which it is implemented and the need to keep the core components that make the intervention effective. This so-called dilemma between fidelity and adaptation is often handled by health professionals in the sustainment phase of an implementation (i.e., once the intervention has been adopted and institutionalized in an organization), but not much is known about how and to what extent health professionals are affected by this dilemma. Focusing on the sustainment phase, this project aims to study (1) how fidelity and adaptation are managed by professionals using an EBI, (2) how the fidelity-adaptation dilemma affects professionals' psychosocial working conditions, and (3) how a structured decision support influences professionals' management of the dilemma and their psychosocial working conditions. METHODS: The study is set in Sweden, and the EBI in focus is a parental program (All Children in Focus). A longitudinal within-person intervention design is used, combined with a cross-sectional survey design. Data sources include web-based questionnaires, brief interviews, fidelity ratings, paper-and-pen questionnaires, and written documentation, collected at multiple time points with both group leaders and parents as respondents. DISCUSSION: This project approaches fidelity and adaptation from the perspective of the professionals that manage EBIs during the sustainment phase of implementation. Although it is well known that EBIs continue to change over time, it remains to be understood how the fidelity-adaptation dilemma can be managed so that the effectiveness of interventions is retained or improved, not diluted. Moreover, the project adds to the literature by presenting an occupational health perspective on the fidelity-adaptation dilemma. It is acknowledged that fidelity and adaptation may have consequences for not only clients but also the occupational wellbeing of the professionals managing the dilemma, and subsequently, their willingness and ability to deliver EBIs in a sustainable way.
Authors: Norbert K Semmer; Nicola Jacobshagen; Laurenz L Meier; Achim Elfering; Terry A Beehr; Wolfgang Kälin; Franziska Tschan Journal: Work Stress Date: 2015-03-02