Submission ID 130799
| Issue/Objective | Implementation fidelity or integrity is the degree to which the intervention or program is delivered as it was intended to be by its developers (Carroll et al., 2007). Complex, community-based health interventions operate in real-world settings where social, organizational, and resource constraints necessitate adaptation, yet excessive flexibility can undermine implementation fidelity and evaluation. The methodological inconsistency in the literature limits interpretability and secondary use. It remains unclear whether this inconsistency reflects limitations in conceptual integration or limited reporting practices. There is variable reporting on where fidelity assessment is situated, whether in process evaluation, outcome analysis, and/or post hoc interpretation. The present study conducts a scoping review of research on assessing fidelity and adaptation of complex community-based health interventions. The tools, methodologies, and integration of fidelity into the implementation and evaluation of these interventions are explored. |
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| Methodology/Approach | Using the Arksey and O'Malley approach, online databases (Ovid MEDLINE, Ovid Emcare, Embase, Global Health, and Google Scholar) were searched to identify English language papers published between 1996-2026. Peer-reviewed journal articles and grey literature were included if they reported on implementation fidelity (adherence, dose, quality of delivery) adaptation (modification, tailoring, contextual adjustments). |
| Results | Studies included assessed and evaluated implementation fidelity and adaptation for complex community-based health interventions across multiple countries and contexts. Various frameworks were utilized with fidelity components assessed ranging from adherence to participants responsiveness. Measurement tools included facilitator questionnaires, audio recordings, observation checklists, and pre/post meeting questionnaires. Moderators were largely captured but linking fidelity findings to intervention outcome measures varied. |
| Discussion/Conclusion | The results of this scoping review will improve the understanding of how fidelity is conceptualized, operationalized, and integrated into the implementation and evaluation of complex, community-based health interventions, and what methodologies are used to assess and track it across contexts. Tracking intervention implementation fidelity and program integrity is an approach toward accountability and addresses the gap between published evidence and real-world implementation. |
| Presenters and Affiliations | Oluwatobi Mohammed Mary Heersink School of Global Health and Social Medicine, McMaster University Reeya Kothari Mary Heersink School of Global Health and Social Medicine, McMaster University Diana Sherifali School of Nursing at McMaster University. Population Health Research Institute Lehana Thabane Department of Health Research Methods, Evidence, and Impact, McMaster University. 3The Research Institute of St Joe's Hamilton, St Joseph's Healthcare Hamilton. Deborah DiLiberto Mary Heersink School of Global Health and Social Medicine, McMaster University |
