Translating Evidence-Based Programs into Community-Based Settings: The Role of Fidelity Observations

Introduction: Translational research aims at wider dissemination of efficacious interventions. Fidelity is a key component in successful translation of efficacious interventions in community-based settings.  It ensures that programs when replicated in different settings are delivered as intended.

Methods: The Healthy Aging Regional Collaborative comprising of 29 local agencies has been disseminating six evidence-based health promotion programs targeting older adults in South Florida since fall of 2008. Trained evaluators observed approximately 30% of randomly selected workshops for each program annually. Fidelity instruments were developed and reflective of core components of interventions. Observations focused on (1) workshop environment, (2) instructor performance, (3) suitability of site, and (4) session content based on developers’ instructor manual.

Results: Trained evaluators observed 295 workshops in four years. The number of workshops with no fidelity concerns increased from 72.3% year 1 to 83.6% in year 4. The percent of workshop observed with fewer than recommended number of participants reduced from approximately 50% in year 1 to approximately 14% in year 4. For instructor performance, two commonly identified issues were (1) instructor not verifying if participants can hear or see them (38%) and (2) not instructing participants to do exercises at their own pace (13.8%). Workshop environment and site well suited the needs of older adults. For session content, results from fidelity observations indicated compliance with prescribed program elements.  

Conclusion: For successful translation of efficacy trials, interventions must be delivered as developed. Through continued monitoring and feedback, local agencies in South Florida achieved high rates of implementation fidelity.