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Implementation Science
Published in: Implementation Science 1/2012

Open Access 01-12-2012 | Research

Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care

Authors: Henna Hasson, Staffan Blomberg, Anna Dunér

Published in: Implementation Science | Issue 1/2012

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Abstract

Background

Prior studies measuring fidelity of complex interventions have mainly evaluated adherence, and not taken factors affecting adherence into consideration. A need for studies that clarify the concept of fidelity and the function of factors moderating fidelity has been emphasized. The aim of the study was to systematically evaluate implementation fidelity and possible factors influencing fidelity of a complex care continuum intervention for frail elderly people.

Methods

The intervention was a systematization of the collaboration between a nurse with geriatric expertise situated at the emergency department, the hospital ward staff, and a multi-professional team with a case manager in the municipal care services for older people. Implementation was evaluated between September 2008 and May 2010 with observations of work practices, stakeholder interviews, and document analysis according to a modified version of The Conceptual Framework for Implementation Fidelity.

Results

A total of 16 of the 18 intervention components were to a great extent delivered as planned, while some new components were added to the model. No changes in the frequency or duration of the 18 components were observed, but the dose of the added components varied over time. Changes in fidelity were caused in a complex, interrelated fashion by all the moderating factors in the framework, i.e., context, staff and participant responsiveness, facilitation, recruitment, and complexity.

Discussion

The Conceptual Framework for Implementation Fidelity was empirically useful and included comprehensive measures of factors affecting fidelity. Future studies should focus on developing the framework with regard to how to investigate relationships between the moderating factors and fidelity over time.

Trial registration

ClinicalTrials.gov, NCT01260493.
Appendix
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Metadata
Title
Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care
Authors
Henna Hasson
Staffan Blomberg
Anna Dunér
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2012
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-7-23

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