The Tug-of-War: Fidelity Versus Adaptation Throughout the Health Promotion Program Life Cycle
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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Researchers have often conceptualized sustainability as the final stage in the overall life cycle of an intervention, including development, adoption, implementation, and sustainability.
“Researchers have often conceptualized sustainability as the final stage in the overall life cycle of an intervention, including development, adoption, implementation (with potential adaptations), and sustainability (14, 31, 52, 110, 115, 118).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [14]
One challenge inherent in studying sustainability is the tension between the continuation of interventions as originally developed and the need to adapt them for use in contexts and populations that may differ from those originally tested and that change over time.
“Therefore, one challenge inherent in studying sustainability is the tension between the continuation of interventions as originally developed and the need to adapt them for use in contexts and populations that may differ from those originally tested and that change over time (7, 14, 23, 118, 122).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [14]
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- Authors
- Bopp, M., Saunders, R. P., & Lattimore, D.
- Affiliations
- Pennsylvania State University (US)
- University of South Carolina (US)
- University of San Francisco (US)
- Corresponding author
- Bopp, Melissa
- Venue
- The Journal of Primary Prevention
- Published
- 2013-03-23
- Volume
- 34
- Issue
- 3
- Pages
- 193-207
- ISSN
- 0278-095X (ISSN-L)
- 1573-6547
- OpenAlex
- W2087834176
- Cited by
- 150
- References
- 53
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 17 · 2023: 14 · 2022: 7 · 2021: 27 · 2020: 22 · 2019: 14 · 2018: 14 · 2017: 5 · 2016: 11 · 2015: 8 · 2014: 1
- FWCI
- 12.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- The Journal of Primary Prevention (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Keywords
- program life cycle, implementation fidelity, health promotion programs, translational research, program dissemination, program adoption, program implementation, program sustainability, stakeholder engagement, intervention design, causal mechanisms, contextual factors
- MeSH terms
- Diffusion of Innovation, Health Promotion, Humans, Program Evaluation, Program Development, Organizational Case Studies
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