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. 2013;113(4):297-323.
doi: 10.1108/09654281311329240.

Understanding the art and science of implementation in the SAAF efficacy trial

Cady Berkel  1 , Velma McBride Murry  2 , Kathryn J Roulston  3 , Gene H Brody  4
Affiliations

Understanding the art and science of implementation in the SAAF efficacy trial

Cady Berkel et al. Health Educ (Lond). 2013.

Abstract

Purpose: The purpose of this paper is to demonstrate the importance of considering both fidelity and adaptation in assessing the implementation of evidence-based programs.

Design/methodology/approach: The current study employs a multi-method strategy to understand two dimensions of implementation (fidelity and adaptation) in the Strong African American Families (SAAF) program. Data were video recordings of program delivery and pre-test and post-test interviews from the efficacy trial. Multilevel regression in Mplus was used to assess the impact of fidelity to the manual, coded by independent observers, on racial socialization outcomes. One activity on racial socialization, a core component of the program, was selected for an in-depth examination using conversation analysis (a qualitative method of analyzing talk in interactions).

Findings: Results of the quantitative analyses demonstrated that fidelity of the selected activity was associated with increases in parent's use of racial socialization from pre-test to post-test, but only when participant attendance was included in the model. Results of the qualitative analyses demonstrated that facilitators were making adaptations to the session and that these adaptations appeared to be in line with cultural competence.

Research limitations/implications: The development of quantitative fidelity measures can be problematic, with many decision points to consider. The current study contributes to the evidence base to develop a quantitative measure of adaptation for family-based parenting programs.

Originality/value: Many researchers examining implementation of evidence-based programs consider fidelity and adaptation to be polar ends of a single spectrum. This paper provides evidence for the importance of examining each independently.

Keywords: Adaptation; African Americans; Evidence base; Fidelity; Implementation; Mixed method; Parenting; Prevention; Programs; Qualitative; Quantitative methods; Rural.

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Figures

Figure 1
Figure 1
Excerpt from the SAAF Manual from Activity 6.2
Figure 2
Figure 2
Fidelity ratings across parent sessions
Figure 3
Figure 3
Difficult terminology (Group 9, instructions)
Figure 4
Figure 4
Ambiguity of Separatist vs Black Pride (Group 13, Vignette 3, Robert-Separatist)
Figure 5
Figure 5
Better ways to handle discrimination (Group 6, Vignette 1, Rosa-Separatist)
Figure 6
Figure 6
Call and response (Group 14, instructions)
See this image and copyright information in PMC

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References

    1. Backer TE. Finding the Balance: Program Fidelity and Adaptation in Substance Abuse Prevention. Center for Substance Abuse Prevention; Rockville, MD: 2002.
    1. Berkel C, Ayers TS, Sandler IN. Untangling the effects of multiple dimensions of implementation in understanding the success of evidence-based programs. Presented at the annual meeting of the Society for Prevention Research; Washington, DC. 2011a.
    1. Berkel C, Mauricio AM, Schoenfelder E, Sandler IN. Putting the pieces together: an integrated model of program implementation. Prevention Science. 2011b;12(1):23–33. - PMC - PubMed
    1. Blakely CH, Mayer JP, Gottschalk RG, Schmitt N, Davidson WS, Roitman DB, Emshoff JG. The fidelity-adaptation debate: implications for the implementation of public sector social programs. American Journal of Community Psychology. 1987;15(3):253–268.
    1. Boatright SR, Bachtel DC, editors. The Georgia County Guide. The University of Georgia, Center for Agribusiness and Economic Development, University of Georgia Cooperative Extension, and Carl Vinson Institute of Government; Athens, GA: 2000.

Further reading

    1. Brownson RC, Colditz GA, Knisley Proctor E. Dissemination and Implementation Research in Health: Translating Science to Practice. Oxford University Press; New York, NY: 2012.

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