Collaborating with Community Partners to Implement Interventions: Implications for Measures of Implementation Fidelity

Introduction: Many consider implementation fidelity vital to the success of evidence-based interventions. Although research findings generally support this belief, studies also indicate that communities often have great difficulty implementing evidence-based interventions with fidelity and are prone to making adaptations. The general response from the field of prevention science to this issue has been to improve training so that implementers understand the importance of implementation fidelity, particularly in regard to the essential components of interventions, and to emphasize the significance of measuring fidelity. Generally, measures of implementation fidelity are intervention specific and vary widely. Common components, however, include coverage of specific topics and activities, amount of time spent delivering the intervention, and participant interest and engagement.

Method: This presentation is designed to extend the conversation about the measurement of implementation fidelity by discussing implementation fidelity in regard to three specific projects that utilize evidence-based programs and practices: a community-wide initiative focused on improving academic achievement and attainment, a community-wide initiative focused on obesity prevention, and a statewide initiative focused on improving the quality and delivery of rehabilitative services for youth on probation.  Community partners for these projects included non-profits, state agencies, public health departments, and community health centers.

Results: Findings suggest that most community partners expect and encourage adaptations to both locally-developed and evidence-based interventions. As a result, promoting strict implementation fidelity of evidence-based interventions often requires a fundamental shift in community partners’ values.  Although the degree to which this shift is achieved contributes to the success or failure of interventions, the importance of this shift often is overlooked in the field of prevention science. 

Discussion: Suggestions to overcome this challenge will be discussed, including developing interventions that can be adapted, modifying measures of community readiness to take into consideration attitudes about implementation fidelity, choosing interventions that align with organizations’ views about implementation fidelity, and measuring beliefs about implementation fidelity. Further, ways to broaden existing measures of implementation fidelity to reflect the realities of partnering with community organizations will be addressed, including not only examining the implementation fidelity of specific lessons, but also taking a holistic view that considers changes in personnel, sequencing of material, and consistency of delivery across topics and activities. Having realistic expectations about implementation fidelity and further investigating the beliefs and practices that promote implementation fidelity have the potential to facilitate the successful implementation of evidence-based interventions by community partners.