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International Journal of Behavioral Medicine
Published in: International Journal of Behavioral Medicine 3/2015

01-06-2015

Investigating Variations in Implementation Fidelity of an Organizational-Level Occupational Health Intervention

Authors: Hanna Augustsson, Ulrica von Thiele Schwarz, Terese Stenfors-Hayes, Henna Hasson

Published in: International Journal of Behavioral Medicine | Issue 3/2015

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Abstract

Background

The workplace has been suggested as an important arena for health promotion, but little is known about how the organizational setting influences the implementation of interventions.

Purpose

The aims of this study are to evaluate implementation fidelity in an organizational-level occupational health intervention and to investigate possible explanations for variations in fidelity between intervention units.

Method

The intervention consisted of an integration of health promotion, occupational health and safety, and a system for continuous improvements (Kaizen) and was conducted in a quasi-experimental design at a Swedish hospital. Implementation fidelity was evaluated with the Conceptual Framework for Implementation Fidelity and implementation factors used to investigate variations in fidelity with the Framework for Evaluating Organizational-level Interventions. A multi-method approach including interviews, Kaizen notes, and questionnaires was applied.

Results

Implementation fidelity differed between units even though the intervention was introduced and supported in the same way. Important differences in all elements proposed in the model for evaluating organizational-level interventions, i.e., context, intervention, and mental models, were found to explain the differences in fidelity.

Conclusion

Implementation strategies may need to be adapted depending on the local context. Implementation fidelity, as well as pre-intervention implementation elements, is likely to affect the implementation success and needs to be assessed in intervention research. The high variation in fidelity across the units indicates the need for adjustments to the type of designs used to assess the effects of interventions. Thus, rather than using designs that aim to control variation, it may be necessary to use those that aim at exploring and explaining variation, such as adapted study designs.
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Metadata
Title
Investigating Variations in Implementation Fidelity of an Organizational-Level Occupational Health Intervention
Authors
Hanna Augustsson
Ulrica von Thiele Schwarz
Terese Stenfors-Hayes
Henna Hasson
Publication date
01-06-2015
Publisher
Springer US
Published in
International Journal of Behavioral Medicine / Issue 3/2015
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-014-9420-8

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