Adaptation and Fidelity: a Recipe Analogy for Achieving Both in Population Scale Implementation

Kemp, Lynn

doi:10.1007/s11121-016-0642-7

Cited by 73Health Policy Implementation ScienceEvaluation and Performance AssessmentHealth Sciences Research and Education

Adaptation and Fidelity: a Recipe Analogy for Achieving Both in Population Scale Implementation

Kemp, Lynn·2016·Prevention Science

DOI 10.1007/s11121-016-0642-7

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Abstract

Balancing adherence to fidelity of evidence-based programs and adaptation to local context is one of the key debates in the adoption and implementation of effective programs. Concern about maintaining fidelity to achieve outcomes can result in replication of research-based models that can be a poor fit with the real world. Equally, unplanned adaptation can result in program drift away from the core elements needed to achieve outcomes. To support implementation of the Maternal Early Childhood Sustained Home-visiting (MECSH) program in multiple sites in three countries, an analogy was developed to identify how both fidelity and adaptation can be managed and successfully achieved. This article presents the Commonsense Cookery Book Basic Plain Cake with Variations recipe analogy to articulate the dual requirements of both fidelity and adaptation to achieve quality implementation of the MECSH program. Components classified by the analogy include identification of core ingredients, methods, and equipment that contribute to fundamental outcomes and fidelity to the evidence-based program, and a planned, collaborative approach to identification of needed variations to suit locally sourced capacity, needs, and tastes. Quality is achieved by identifying and measuring the core ingredients and the variations. Sourcing local ingredients and honoring of context support sustainability of quality practice. Using this analogy has assisted adopters of the MECSH program to understand that effective implementation requires uncompromised commitment to expectations of fidelity to the core components and methods; planned, proactive adaptation; systematic monitoring of both core program and agreed variations; and local ownership and sustainability.

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The adaptation-fidelity tension is a critical component of scaling-out and is addressed head on in more dynamic models of implementation process.
“This “adaptation-fidelity” tension is a critical component of scaling-out in that it is addressed head on as proposed in more dynamic models of implementation process [60–62].”
From “Scaling-out” evidence-based interventions to new populations or new health care delivery systems (2017) · cites this paper as [61]

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Authors: Kemp, L.
Affiliations: Liverpool Hospital (AU)
Corresponding author: Kemp, Lynn
ORCID: Kemp, Lynn
Venue: Prevention Science
Publisher: Springer Science and Business Media LLC
Published: 2016-03-11
Volume: 17
Issue: 4
Pages: 429-438
ISSN: 1389-4986 (ISSN-L)
1573-6695
DOI: 10.1007/s11121-016-0642-7
OpenAlex: W2295416235
Cited by: 73
References: 38
Citations by year: 2026: 5 · 2025: 7 · 2024: 13 · 2023: 7 · 2022: 6 · 2021: 7 · 2020: 7 · 2019: 9 · 2018: 7 · 2017: 2 · 2016: 2
FWCI: 12.44
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: Prevention Science (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 › Health Sciences Research and Education
Keywords: implementation fidelity, program adaptation, evidence-based programs, implementation, home visits, program monitoring, local ownership, sustainability, maternal and child health
MeSH terms: Humans, Program Evaluation, Program Development, Evidence-Based Practice

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Adaptation and Fidelity: a Recipe Analogy for Achieving Both in Population Scale Implementation

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