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Fidelity & Implementation (GT)
This initial or rough draft of a summary (formatted in an glossary format) has been started by the International School Health Network.Visitors to and members of this wiki-based web site are welcome to edit the draft (using the Easy Edit" tool found at the top of the page or to comment on the draft by using the "discussion thread" tool found at the bottom of the page. (All previous versions of this page are automatically saved by the system, so don't hesitate to edit this page). You can also make a more general comment about this web site or about the topic of this summary by using posting in our Discussions Forum.
Dusenbury et al (2003) have discussed fidelity and suggest that fidelity of implementation refers to the degree to which a stipulated policy, a specified program or service or a evidence-based, specifically described better practice has been adopted and implemented by professionals such as teachers, health professionals or other program/service providers as intended by the developers of the policies, programs/services. While there is agreement generally about what is intended when research refers to fidelity, in fact, fidelity has come to refer to a broad and loosely collected set of specific definitions.
Discussions of fidelity become even more complicated when one considers fidelity in pursuing a comprehensive approaches, the coordination of agency and school programs or whole school strategies such as healthy schools, community schools or effective schools where multiple interventions are recommended as the better practice. Further, in recent years, attention has turned to the use of ecological and systems-based approaches that pay considerably more attention to the local context, the complex interactions between individual children, their families, neighbourhoods, and communities as well as the characteristics of open, loosely coupled, adaptive and bureaucratic systems.
In 2003, Dusenbury et all described the diversity of definitions given to fidelity of implementation as including:
Diffusion of innovation theory (Rogers, 1995) provides a way of understanding the process by which new ideas are put into practice. It has been used to understand ideas in a number of areas, including education, psychology and public health. In the early days of the theory, most of the emphasis was on program adoption. In the 1960s and 1970s the Research, Development and Diffusion (RD & D) model was commonly used by policy makers. This model emphasized the importance of rigorous evaluation and validation in demonstration projects. A basic assumption of this model was that professionals in the field would value the results of these evaluation studies and base their decisions about whether to adopt an innovation. Professionals, managers, officials and policy-makers were viewed as largely passive in this model and it was expected that programs would be implemented by consumers as intended by program developers (Rogers, 19950).
The assumptions of this model were called into question beginning in the mid-to-late 1970s when various authors argued that various characteristics of individual organizations had a powerful influence on whether or not programs were adopted and the extent to which they would be implemented with fidelity. For example, a Rand report (Berman and McLaughlin, 1976) which analyzed federal programs supporting educational innovation found that teacher-proof programs or ‘pure technologies’ did not exist in practice.The Rand report observed three patterns of implementation in innovative educational programs: (1) cooptation or adapting the program without any changes in organizational behavior, (2) mutual adaptation in which the program is adapted at the same time there are changes in the organization, and (3) non-implementation and non-adoption in which neither happened.High-quality implementation simply did not exist in practice. The Rand report revealed that programs that were mutually adapted were more effective than coopted programs. Only with mutual adaptation did organizational behavior change.
Critics have noted a number of problems which raise serious questions about the conclusions of the Rand report. For example, programs studied in the Rand report could be described more accurately as general policy changes rather than specific, detailed curricula or programs. In addition, the instrument designed to measure implementation assessed ‘the extent to which projects met their own goals, different as they might be for each project. They did not actually assess component specific fidelity’ to a specified program. Finally, the measures relied in many cases on self-reports by users and were very global
Before continuing the debate about fidelity as it has been discussed above, it is more useful to first discuss to what we are seeking fidelity and by whom. Is it a general policy goal such as implementation of a health education curriculum (which has multiple learning objectives), or a specific policy such as prohibiting junk foods in schools? Is it the implementation of a better practice such as counsellors/social workers using theory based clinical practices or health, education and other ministries seeking to implement multi-intervention programs rather than single interventions? Or is it fidelity to a specific program that has been implemented and tested in controlled and likely artificial or specific circumstances? Or, is the fidelity to a systematic change or improvement such as seeking to have an increasing number of schools achieving accredited status as a healthy school?
References:
Carol L. O’Donnell (2008) Defining, Conceptualizing, and Measuring Fidelity of Implementation and Its Relationship to Outcomes in K–12 Curriculum Intervention Research REVIEW OF EDUCATIONAL RESEARCHMarch 2008vol. 78no. 133-84
Dusenbury L, Brannigan R, Falco M, Hansen WB (2003) A review of research on fidelity of implementation: implications for drug abuse prevention in school settings Health Education Research, Vol. 18, No. 2, 237-256, April 2003
Elliott DS , Mihalic S (2004) Issues in Disseminating and Replicating Effective Prevention Programs PREVENTION SCIENCE Volume 5, Number1,47-53,DOI:10.1023/B:PREV.0000013981.28071.52
Hill LG,Maucione K, Hood BK (2008) A Focused Approach to Assessing Program Fidelity PREVENTION SCIENCE Volume 8, Number 1,25-34,DOI:10.1007/s11121-006-0051-4
Fidelity in Implementing an Approach, Policy, Better Practice, Specified Program or Overall Service or System Improvement
Dusenbury et al (2003) have discussed fidelity and suggest that fidelity of implementation refers to the degree to which a stipulated policy, a specified program or service or a evidence-based, specifically described better practice has been adopted and implemented by professionals such as teachers, health professionals or other program/service providers as intended by the developers of the policies, programs/services. While there is agreement generally about what is intended when research refers to fidelity, in fact, fidelity has come to refer to a broad and loosely collected set of specific definitions.
Discussions of fidelity become even more complicated when one considers fidelity in pursuing a comprehensive approaches, the coordination of agency and school programs or whole school strategies such as healthy schools, community schools or effective schools where multiple interventions are recommended as the better practice. Further, in recent years, attention has turned to the use of ecological and systems-based approaches that pay considerably more attention to the local context, the complex interactions between individual children, their families, neighbourhoods, and communities as well as the characteristics of open, loosely coupled, adaptive and bureaucratic systems.
In 2003, Dusenbury et all described the diversity of definitions given to fidelity of implementation as including:
- strict adherence to methods or implementation that conforms to theoretical guidelines (particularly when the intervention is adapted to meet the needs of specific circumstances),
- completeness and dosage of implementation,
- the quality of program delivery (the way a teacher implements a program),
- the degree to which participants are engaged, and
- program differentiation (the degree to which elements which would distinguish one type of program from another are present or absent).
Diffusion of innovation theory (Rogers, 1995) provides a way of understanding the process by which new ideas are put into practice. It has been used to understand ideas in a number of areas, including education, psychology and public health. In the early days of the theory, most of the emphasis was on program adoption. In the 1960s and 1970s the Research, Development and Diffusion (RD & D) model was commonly used by policy makers. This model emphasized the importance of rigorous evaluation and validation in demonstration projects. A basic assumption of this model was that professionals in the field would value the results of these evaluation studies and base their decisions about whether to adopt an innovation. Professionals, managers, officials and policy-makers were viewed as largely passive in this model and it was expected that programs would be implemented by consumers as intended by program developers (Rogers, 19950).
The assumptions of this model were called into question beginning in the mid-to-late 1970s when various authors argued that various characteristics of individual organizations had a powerful influence on whether or not programs were adopted and the extent to which they would be implemented with fidelity. For example, a Rand report (Berman and McLaughlin, 1976) which analyzed federal programs supporting educational innovation found that teacher-proof programs or ‘pure technologies’ did not exist in practice.The Rand report observed three patterns of implementation in innovative educational programs: (1) cooptation or adapting the program without any changes in organizational behavior, (2) mutual adaptation in which the program is adapted at the same time there are changes in the organization, and (3) non-implementation and non-adoption in which neither happened.High-quality implementation simply did not exist in practice. The Rand report revealed that programs that were mutually adapted were more effective than coopted programs. Only with mutual adaptation did organizational behavior change.
Critics have noted a number of problems which raise serious questions about the conclusions of the Rand report. For example, programs studied in the Rand report could be described more accurately as general policy changes rather than specific, detailed curricula or programs. In addition, the instrument designed to measure implementation assessed ‘the extent to which projects met their own goals, different as they might be for each project. They did not actually assess component specific fidelity’ to a specified program. Finally, the measures relied in many cases on self-reports by users and were very global
Before continuing the debate about fidelity as it has been discussed above, it is more useful to first discuss to what we are seeking fidelity and by whom. Is it a general policy goal such as implementation of a health education curriculum (which has multiple learning objectives), or a specific policy such as prohibiting junk foods in schools? Is it the implementation of a better practice such as counsellors/social workers using theory based clinical practices or health, education and other ministries seeking to implement multi-intervention programs rather than single interventions? Or is it fidelity to a specific program that has been implemented and tested in controlled and likely artificial or specific circumstances? Or, is the fidelity to a systematic change or improvement such as seeking to have an increasing number of schools achieving accredited status as a healthy school?
| Fidelity to What | Fidelity from Ministries & Governments | Fidelity from Agencies and School Boards | Fidelity from Schools, School Administrators and Related Staff Assigned to work with schools from other Agencies | Fidelity from Teachers | Fidelity or cooperation from other professionals, parents, youth grouips etc |
| Building capacity and change to improve the quality of the school-community-neighbourhood-family ecosystems | |||||
| Identifying, developing, implementing, maintaining and adapting a multi-intervention approach, coordinated agency-school programs or whole school strategy (eg healthy schools, community schools, SEL, safe schools, etc) | |||||
Developing, implementing, maintaining and reporting on progress related to a) a general policy (eg implementing a comprehensive approach) b) a specific policy addressing an issue, student population or school, agency or professional practice (eg school food sales, standards for school-based or school-linked delivery of health service, information, screening or testing etc) | |||||
Developing, implementing, maintaining, adapting and evaluating:a) a specific instructional program or b) a general provincial/state curriculum | |||||
Developing, implementing, maintaining, adapting and evaluating a health, social or other service delivered with or within schools such as:a) role, training of nurses | |||||
Developing, implementing, maintaining programs to increase social support such as:a) a general youth development/ engagement strategy | |||||
Developing, implementing and maintaining programs or requirements to improve the physical environment or practical resources in schools such as:a) criteria for the construction of healthy schools and school grounds |
References:
Carol L. O’Donnell (2008) Defining, Conceptualizing, and Measuring Fidelity of Implementation and Its Relationship to Outcomes in K–12 Curriculum Intervention Research REVIEW OF EDUCATIONAL RESEARCHMarch 2008vol. 78no. 133-84
Dusenbury L, Brannigan R, Falco M, Hansen WB (2003) A review of research on fidelity of implementation: implications for drug abuse prevention in school settings Health Education Research, Vol. 18, No. 2, 237-256, April 2003
Elliott DS , Mihalic S (2004) Issues in Disseminating and Replicating Effective Prevention Programs PREVENTION SCIENCE Volume 5, Number1,47-53,DOI:10.1023/B:PREV.0000013981.28071.52
Hill LG,Maucione K, Hood BK (2008) A Focused Approach to Assessing Program Fidelity PREVENTION SCIENCE Volume 8, Number 1,25-34,DOI:10.1007/s11121-006-0051-4
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, Jan 31 2012, 10:10 AM EST
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