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Navigating fidelity-adaptation dilemmas during the application of evidence-based interventions
Mälardalens universitet, Akademin för hälsa, vård och välfärd.ORCID-id: 0009-0002-1697-1867
2025 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Modern health and welfare services are increasingly characterized by standardized methods and growing demands for services to be grounded in scientific findings. At the same time, professionals are expected to exercise judgment to meet individual needs. This thesis explores how this tension manifests in the way that professionals navigate fidelity–adaptation dilemmas while providing parenting programs in community settings in Sweden. 

Through a combination of qualitative interviews and a discrete choice experiment, this thesis examines (1) the circumstances that trigger adaptations, (2) the nature and consistency of modifications made to programs, and (3) how professionals weigh different outcomes when making adaptation decisions. 

The findings demonstrate that fidelity–adaptation decisions are pervasive and dynamic, occurring even in well-implemented programs. Study I identifies 11 distinct reasons facilitators recognize for making adaptations. Study II reveals that practitioners’ capacity to make thoughtful adjustments while maintaining program integrity varies considerably. Study III illuminates the breadth of outcomes valued by providers and recipients, highlighting the complex multi-goal context of program delivery. Study IV quantifies how professionals prioritize these different outcomes and finds that relationship quality most strongly influences adaptation decisions.

The findings demonstrate that fidelity–adaptation decisions are pervasive and dynamic, occurring even in well-implemented programs. These decisions reflect the complex interplay between practitioners’ professional judgment, working conditions, and organizational demands. This thesis shows how practitioners actively negotiate competing professional demands in their daily work, demonstrates how organizational contexts and governance structures shape professional discretion, and highlights the importance of creating supportive work environments that enable practitioners to make informed decisions while managing multiple organizational goals. These insights suggest that sustainable implementation requires approaches that recognize and support practitioners’ professional agency while acknowledging the complex organizational realities in which they operate.

Ort, förlag, år, upplaga, sidor
Västerås: Mälardalens universitet, 2025.
Serie
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 424
Nyckelord [en]
fidelity-adaptation; implementation; evidence-based interven-tions; parenting programs; applied decision-making; discrete choice experi-ment
Nationell ämneskategori
Hälsovetenskaper
Forskningsämne
arbetslivsvetenskap
Identifikatorer
URN: urn:nbn:se:mdh:diva-69191ISBN: 978-91-7485-692-7 (tryckt)OAI: oai:DiVA.org:mdh-69191DiVA, id: diva2:1915952
Disputation
2025-01-31, Beta och digitalt via Zoom, Mälardalens universitet, Västerås, 13:15 (Engelska)
Opponent
Handledare
Tillgänglig från: 2024-11-26 Skapad: 2024-11-26 Senast uppdaterad: 2025-01-10Bibliografiskt granskad
Delarbeten
1. Eleven Reasons for Adaptation of Swedish Parenting Programs
Öppna denna publikation i ny flik eller fönster >>Eleven Reasons for Adaptation of Swedish Parenting Programs
2022 (Engelska)Ingår i: Frontiers in Health Services, E-ISSN 2813-0146, Vol. 2, artikel-id 923504Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

While questions about adaptation and fidelity are of great concern in manyimplementation projects, less attention has been paid to reasons for adaptations thatremain when evidence-based interventions (EBIs) are used in clinical and communitysettings. This study aims to explore reasons for adaptations that can arise whenusing parenting programs in a community setting. Seventeen individual interviewswith providers were conducted and analyzed thematically, resulting in 11 reasonsfor adaptations organized into four separate areas: characteristics of group leaders(supplementary skills and knowledge, preferred ways of working), characteristics offamilies (problem complexity, diverse or limited educational experience, non-parentingneeds for support, colliding value systems), group incidents (criticism and challenges,excessive questions or discussions), and didactic challenges (lack of focus orengagement, limitations of the material, language differences). The study shows thatfactors triggering adaptation and fidelity decisions continuously reappear in the provisionof parenting programs in community settings. Knowledge about reasons for adaptationcan be used to inform decision-making during implementation planning, as well as thesustainment of implemented interventions.

Nyckelord
parenting program, adaptation, fidelity-adaptation, implementation, sustainment, cultural adaptation, parental support, evidence-based intervention
Nationell ämneskategori
Sociologi (exklusive socialt arbete, socialpsykologi och socialantropologi)
Identifikatorer
urn:nbn:se:mdh:diva-59865 (URN)10.3389/frhs.2022.923504 (DOI)001112642600001 ()
Tillgänglig från: 2022-09-02 Skapad: 2022-09-02 Senast uppdaterad: 2024-11-26Bibliografiskt granskad
2. Fidelity-consistency and deliberateness of modifications in parenting programs
Öppna denna publikation i ny flik eller fönster >>Fidelity-consistency and deliberateness of modifications in parenting programs
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2024 (Engelska)Ingår i: Implementation Science Communications, E-ISSN 2662-2211, Vol. 5, nr 1, artikel-id 13Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Evidence-based interventions (EBIs) are frequently modified in practice. It is recommended that decisions to modify EBIs should be made deliberately to ensure fidelity-consistency, yet the relationship between fidelity-consistency and deliberateness is not well understood. This study aims to explore modifications in a sample of practitioners delivering evidence-based parenting programs (i.e., interventions to strengthen parent–child relationships, reduce harmful interactions, and improve child health and well-being). The study investigated three research questions: (1) What kind of modifications are made during the delivery of parenting programs? (2) To what degree are the identified modifications consistent with the core functions of each program? and (3) Is deliberateness associated with the fidelity-consistency of the identified modifications? Methods: In total, 28 group leaders of five widely disseminated parenting programs in Sweden participated in five focus groups, and two participants from each group also participated in individual interviews (n = 10). A content analysis approach was used where the identification of modifications was directed by the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and then assessed for fidelity-consistency and four levels of deliberateness (universal, situational, conditional, and unintentional). Chi-square tests were performed to compare consistent and inconsistent modifications, and logistic regression was performed to explore whether deliberateness predicted consistency. Results: A total of 137 content modifications were identified, covering most of the content modification categories in FRAME. The most common were tailoring/tweaking/refining, adding elements, shortening/condensing, lengthening/extending, and integrating another treatment. Modifications were mostly fidelity-consistent but consistency varied greatly among categories. Furthermore, modifications made unintentionally or situationally were more likely to be fidelity-inconsistent. Conclusions: These results indicate that explicit consideration of modifications and their impact could be essential for sustaining the fidelity-consistent use of EBIs, even as such interventions are continuously modified.

Ort, förlag, år, upplaga, sidor
BioMed Central Ltd, 2024
Nyckelord
Adaptation, Core components, Core functions, Fidelity, Implementation, Modification, Parenting programs
Nationell ämneskategori
Hälsovetenskaper
Identifikatorer
urn:nbn:se:mdh:diva-66155 (URN)10.1186/s43058-024-00545-4 (DOI)2-s2.0-85185254406 (Scopus ID)
Tillgänglig från: 2024-02-28 Skapad: 2024-02-28 Senast uppdaterad: 2024-11-26Bibliografiskt granskad
3. Valued outcomes across stakeholders of parenting programs in Sweden
Öppna denna publikation i ny flik eller fönster >>Valued outcomes across stakeholders of parenting programs in Sweden
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nationell ämneskategori
Annan samhällsvetenskap
Identifikatorer
urn:nbn:se:mdh:diva-69308 (URN)
Tillgänglig från: 2024-12-06 Skapad: 2024-12-06 Senast uppdaterad: 2024-12-06Bibliografiskt granskad
4. Outcome preferences in fidelity–adaptation scenarios across evidence-based parenting programs: A discrete choice experiment
Öppna denna publikation i ny flik eller fönster >>Outcome preferences in fidelity–adaptation scenarios across evidence-based parenting programs: A discrete choice experiment
Visa övriga...
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nationell ämneskategori
Psykologi (exklusive tillämpad psykologi)
Identifikatorer
urn:nbn:se:mdh:diva-69309 (URN)
Tillgänglig från: 2024-12-06 Skapad: 2024-12-06 Senast uppdaterad: 2024-12-06Bibliografiskt granskad

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