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The Tug-of-War: Fidelity Versus Adaptation Throughout the Health Promotion Program Life Cycle

  • Research Methods and Practice
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Abstract

Researchers across multiple fields have described the iterative and nonlinear phases of the translational research process from program development to dissemination. This process can be conceptualized within a “program life cycle” framework that includes overlapping and nonlinear phases: development, adoption, implementation, maintenance, sustainability or termination, and dissemination or diffusion, characterized by tensions between fidelity to the original plan and adaptation for the setting and population. In this article, we describe the life cycle (phases) for research-based health promotion programs, the key influences at each phase, and the issues related to the tug-of-war between fidelity and adaptation throughout the process using a fictionalized case study based on our previous research. This article suggests the importance of reconceptualizing intervention design, involving stakeholders, and monitoring fidelity and adaptation throughout all phases to maintain implementation fidelity and completeness. Intervention fidelity should be based on causal mechanisms to ensure effectiveness, while allowing for appropriate adaption to ensure maximum implementation and sustainability. Recommendations for future interventions include considering the determinants of implementation including contextual factors at each phase, the roles of stakeholders, and the importance of developing a rigorous, adaptive, and flexible definition of implementation fidelity and completeness.

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Authors and Affiliations

  1. Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, 266 Recreation Building, University Park, PA, 16802, USA

    Melissa Bopp

  2. Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Ruth P. Saunders

  3. Department of Exercise and Sport Science, College of Arts and Sciences, University of San Francisco, San Francisco, CA, USA

    Diana Lattimore

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  1. Melissa Bopp
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  2. Ruth P. Saunders
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  3. Diana Lattimore
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Correspondence to Melissa Bopp.

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Bopp, M., Saunders, R.P. & Lattimore, D. The Tug-of-War: Fidelity Versus Adaptation Throughout the Health Promotion Program Life Cycle. J Primary Prevent 34, 193–207 (2013). https://doi.org/10.1007/s10935-013-0299-y

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