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Cited by 19Health Policy Implementation ScienceHealth Sciences Research and EducationEvaluation and Performance Assessment

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Fidelity, not adaptation, is essential for implementation

Open access
Fixsen, Dean L.·2025·Frontiers in Health Services
DOI 10.3389/frhs.2025.1575179PMC PMC12061988
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Abstract

Fidelity is not yet a requirement when developing an evidence-based innovation or when attempting to use an innovation in typical settings. Currently, users are encouraged to adapt innovations to fit existing practitioner skills and organization situations. Instead of adapting innovations, the essential components of an innovation need to be established in the original research and the essential components need to be used in practice with the support of implementation processes so that promised outcomes can be realized. Fidelity is an assessment of the presence and strength of the essential components that define the independent variable (the innovation) and is directly linked to outcomes. A test of any fidelity assessment is a high correlation (0.70+) with outcomes. The functional relationship between fidelity and outcomes ensures that the essential components are effective and ensures that a reliable fidelity assessment is available. Implementation is the planned process of putting something into effect. Evidence that an innovation has been put into effect is provided by the fidelity assessment. High fidelity scores indicate that the essential components of the innovation are in place and good outcomes are expected. A test of any planned process is fidelity of the use of the innovation. At present fidelity assessments are missing or inadequate and, therefore, there is a notable lack of evidence that an independent variable is present.

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Research works printed but not linked: 85

  1. Albers, 2024, Firm, yet flexible: a fidelity debate paper with two case examples, Implement Sci, 19, 79, 10.1186/s13012-024-01406-3 · DOI · Paper page
  2. Chambers, 2023, Advancing adaptation of evidence-based interventions through implementation science: progress and opportunities, Front Health Serv, 3, 1204138, 10.3389/frhs.2023.1204138 · DOI
  3. Schoenwald, 2013, A review of treatment adherence measurement methods, Psychol Assess, 25, 146, 10.1037/a0029715 · DOI
  4. An, 2020, What really works in intervention? Using fidelity measures to support optimal outcomes, Phys Ther, 100, 757, 10.1093/ptj/pzaa006 · DOI
  5. Tommeraas, 2016, Is there a scale-up penalty? Testing behavioral change in the scaling up of parent management training in Norway, Adm Policy Ment Health, 44, 203, 10.1007/s10488-015-0712-3 · DOI
  6. Beard, 1995, Theory construction and testing: an introduction and overview, 1
  7. Popper, 1963, Conjectures and Refutations: The Growth of Scientific Knowledge
  8. Fixsen, 2024, Is implementation science a science? Not yet, Front Public Health, 12, 1454268, 10.3389/fpubh.2024.1454268 · DOI
  9. Dusenbury, 2003, A review of research on fidelity of implementation: implications for drug abuse prevention in school settings, Health Educ Res, 18, 237, 10.1093/her/18.2.237 · DOI · Paper page
  10. Dobson, 1980, Avoiding type III error in program evaluation: results from a field experiment, Eval Program Plann, 3, 269, 10.1016/0149-7189(80)90042-7 · DOI · Paper page
  11. Durlak, 2008, Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation, Am J Community Psychol, 41, 327, 10.1007/s10464-008-9165-0 · DOI · Paper page
  12. Lemire, 2023, A comparison of fidelity implementation frameworks used in the field of early intervention, Am J Eval, 44, 236, 10.1177/10982140211008978 · DOI
  13. Cross, 2024, Measuring fidelity of brief cognitive behavior therapy for insomnia: development, reliability and validity, Eval Program Plann, 109, 102531, 10.1016/j.evalprogplan.2024.102531 · DOI
  14. 2002, Washington State's Implementation of Functional Family Therapy for Juvenile Offenders: Preliminary Findings
  15. Sexton, 2000, Functional family therapy, Juv Justice Bull, 1
  16. Alexander, 2000, Functional family therapy, 3
  17. Alexander, 1973, Short-term family intervention: a therapy outcome study, J Consult Clin Psychol, 2, 195
  18. Tofail, 2018, Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH benefits Bangladesh): a cluster-randomised controlled trial, Lancet Child Adolesc Health, 2, 255, 10.1016/S2352-4642(18)30031-2 · DOI
  19. Rahman, 2018, WASH benefits Bangladesh trial: system for monitoring coverage and quality in an efficacy trial, Trials, 19, 360, 10.1186/s13063-018-2708-2 · DOI
  20. Masud Parvez, 2018, Achieving optimal technology and behavioral uptake of single and combined interventions of water, sanitation hygiene and nutrition, in an efficacy trial (WASH benefits) in rural Bangladesh, Trials, 19, 1, 10.1186/s13063-018-2710-8 · DOI
  21. Damschroder, 2009, Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science, Implement Sci, 4, 1, 10.1186/1748-5908-4-50 · DOI · Paper page
  22. Fixsen, 2005, Implementation Research: A Synthesis of the Literature: National Implementation Research Network, iii-119
  23. Rycroft-Malone, 2004, The PARIHS framework: a framework for guiding the implementation of evidence-based practice, J Nurs Care Qual, 19, 297, 10.1097/00001786-200410000-00002 · DOI · Paper page
  24. Greenhalgh, 2004, Diffusion of innovations in service organizations: systematic review and recommendations, Milbank Q, 82, 581, 10.1111/j.0887-378X.2004.00325.x · DOI · Paper page
  25. Koestler, 1967, The Ghost in the Machine
  26. Fixsen, 2019, Implementation Practice and Science, 378
  27. Schoenwald, 2004, Toward effective quality assurance in evidence-based practice: links between expert consultation, therapist fidelity, and child outcomes, J Clin Child Adolesc Psychol, 33, 94, 10.1207/S15374424JCCP3301_10 · DOI
  28. Fixsen, 2023, Repeated measures of implementation variables, Front Health Serv, 3, 1, 10.3389/frhs.2023.1085859 · DOI
  29. Jacobs, 2018, Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups, Implement Sci, 13, 74, 10.1186/s13012-018-0766-1 · DOI
  30. Skogøy, 2018, Hospitals implementing changes in law to protect children of ill parents: a cross-sectional study, BMC Health Serv Res, 18, 609, 10.1186/s12913-018-3393-2 · DOI
  31. Joyce, 2002, Student Achievement Through Staff Development, 217
  32. Nord, 1987, Implementing Routine and Radical Innovations
  33. Hirschhorn, 2015, Learning before leaping: integration of an adaptive study design process prior to initiation of BetterBirth, a large-scale randomized controlled trial in Uttar Pradesh, India, Implement Sci, 10, 1, 10.1186/s13012-015-0309-y · DOI
  34. Webster-Stratton, 2014, Improving therapist fidelity during implementation of evidence-based practices: incredible years program, Psychiatr Serv, 65, 789, 10.1176/appi.ps.201200177 · DOI
  35. Epstein, 2013, When is a program ready for rigorous impact evaluation? The role of a falsifiable logic model, Eval Rev, 36, 375, 10.1177/0193841X12474275 · DOI
  36. Genov, 2005, Iterative usability testing as continuous feedback: a control systems perspective, J Usability Stud, 1, 18
  37. Nielsen, 2005, Usability for the masses, J Usability Stud, 1, 2
  38. Akin, 2013, Usability testing, initial implementation, and formative evaluation of an evidence-based intervention: lessons from a demonstration project to reduce long-term foster care, Eval Program Plann, 41, 19, 10.1016/j.evalprogplan.2013.06.003 · DOI
  39. Speroff, 2004, Study designs for PDSA quality improvement research, Qual Manag Health Care, 13, 17, 10.1097/00019514-200401000-00002 · DOI
  40. Taylor, 2014, Systematic review of the application of the plan–do–study–act method to improve quality in healthcare, BMJ Qual Saf, 23, 290, 10.1136/bmjqs-2013-001862 · DOI · Paper page
  41. Shewhart, 1939, Statistical Method from the Viewpoint of Quality Control
  42. McNicholas, 2019, Evolving quality improvement support strategies to improve plan–do–study–act cycle fidelity: a retrospective mixed-methods study, BMJ Qual Saf, 28, 356, 10.1136/bmjqs-2017-007605 · DOI
  43. Barker, 2016, A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa, Implement Sci, 11, 12, 10.1186/s13012-016-0374-x · DOI · Paper page
  44. Schoenwald, 2000, Inside multisystemic therapy: therapist, supervisory, and program practices, J Emot Behav Disord, 8, 113, 10.1177/106342660000800207 · DOI
  45. 2000, Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda
  46. 2010, The Condition of Education
  47. McGinty, 2024, The lancet psychiatry commission: transforming mental health implementation research, Lancet Psychiatry, 11, 368, 10.1016/S2215-0366(24)00040-3 · DOI
  48. 2015, Health in 2015: From MDGs, Millennium Development Goals to SDGs, Sustainable Development Goals
  49. 2023, The Sustainable Development Goals Report
  50. Altman, 2001, The revised CONSORT statement for reporting randomized trials: explanation and elaboration, Ann Intern Med, 134, 663, 10.7326/0003-4819-134-8-200104170-00012 · DOI · Paper page
  51. Blase, 2013, Core Intervention Components: Identifying and Operationalizing What Makes Programs Work
  52. Hall, 1977, A developmental model for determining whether the treatment is actually implemented, Am Educ Res J, 14, 263, 10.3102/00028312014003263 · DOI
  53. Hall, 2011, Implementing Change: Patterns, Principles and Potholes
  54. Bond, 2004, Prediction of outcome from the dartmouth assertive community treatment fidelity scale, CNS Spectr, 9, 937, 10.1017/S1092852900009792 · DOI
  55. Winter, 2001, Replication as strategy, Organ Sci, 12, 730, 10.1287/orsc.12.6.730.10084 · DOI
  56. Huaynoca, 2013, Scaling up comprehensive sexuality education in Nigeria: from national policy to nationwide application, Sex Educ, 14, 191, 10.1080/14681811.2013.856292 · DOI
  57. Fixsen, 2017, Scaling effective innovations, Criminol Public Policy, 16, 487, 10.1111/1745-9133.12288 · DOI
  58. Strain, 2021, On expanding the definition and use of procedural fidelity, Res Pract Persons Severe Disabl, 46, 173, 10.1177/15407969211036911 · DOI
  59. Fenner, 1988, Smallpox and its Eradication
  60. Foege, 2011, House on Fire: The Fight to Eradicate Smallpox
  61. Braukmann, 1975, Achievement place: the training and certification of teaching-parents, 131
  62. Bedlington, 1988, A comparison of treatment environments in community-based group homes for adolescent offenders, Crim Justice Behav, 15, 349, 10.1177/0093854888015003007 · DOI
  63. Bedlington, 1978, Evaluating Group Homes: The Relationship Between Parenting Behaviors and Delinquency, 1
  64. Blase, 1984, Residential treatment for troubled children: developing service delivery systems, 149
  65. Fixsen, In search of program implementation: 792 replications of the teaching-family model, Behav Anal Today, 8, 96, 10.1037/h0100104 · DOI
  66. Fixsen, 2018, The teaching-family model: the first 50 years, Perspect Behav Sci, 42, 189, 10.1007/s40614-018-0168-3 · DOI
  67. Horner, 2000, A school-wide approach to student discipline, School Admin, 57, 20
  68. Sugai, 2000, Preventing school violence: the use of office discipline referrals to assess and monitor school-wide discipline interventions, J Emot Behav Disord, 8, 94, 10.1177/106342660000800205 · DOI
  69. Horner, 2004, The school-wide evaluation tool (SET): a research instrument for assessing school-wide positive behavior support, J Posit Behav Interv, 6, 3, 10.1177/10983007040060010201 · DOI
  70. Kim, 2025, Empirically deriving cut scores in the positive behavioral interventions and supports (PBIS) tiered fidelity inventory (TFI) through a bookmarking process, J Posit Behav Interv, 27, 94, 10.1177/10983007241276536 · DOI
  71. McIntosh, 2016, Identifying and predicting distinct patterns of implementation in a school-wide behavior support framework, Prev Sci, 17, 992, 10.1007/s11121-016-0700-1 · DOI
  72. Miller, 2004, A randomized trial of methods to help clinicians learn motivational interviewing, J Consult Clin Psychol, 72, 1050, 10.1037/0022-006X.72.6.1050 · DOI · Paper page
  73. Martino, 2008, Community program therapist adherence and competence in motivational enhancement therapy, Drug Alcohol Depend, 96, 37, 10.1016/j.drugalcdep.2008.01.020 · DOI
  74. Martino, 2008, A step forward in teaching addiction counselors how to supervise motivational interviewing using a clinical trials training approach, J Teach Addict, 6, 39, 10.1080/15332700802127946 · DOI
  75. Forgatch, 2005, Evaluating fidelity: predictive validity for a measure of competent adherence to the Oregon model of parent management training, Behav Ther, 36, 3, 10.1016/S0005-7894(05)80049-8 · DOI · Paper page
  76. Sigmarsdóttir, 2018, Implementing an evidence-based intervention for children in Europe: evaluating the full-transfer approach, J Clin Child Adolesc Psychol, 48, 1, 10.1080/15374416.2018.1466305 · DOI
  77. Ogden, 2012, Measurement of implementation components ten years after a nationwide introduction of empirically supported programs—a pilot study, Implement Sci, 7, 49, 10.1186/1748-5908-7-49 · DOI
  78. Naleppa, 2010, Treatment fidelity in social work intervention research: a review of published studies, Res Soc Work Pract, 20, 674, 10.1177/1049731509352088 · DOI
  79. Harrison, 2017, Integrated dual disorder treatment: fidelity and implementation over time, Soc Work Res, 41, 111, 10.1093/swr/svx002 · DOI
  80. Harrison, 2019, Ten years of implementation: assertive community treatment and integrated dual disorder treatment in a statewide system, Arch Psychol, 3, 1, 10.31296/aop.v3i2.92 · DOI
  81. Aarons, 2009, The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: evidence for a protective effect, J Consult Clin Psychol, 77, 270, 10.1037/a0013223 · DOI
  82. Bond, 1997, A fidelity scale for the individual placement and support model of supported employment, Rehabil Couns Bull, 40, 265
  83. McGrew, 1994, Measuring the fidelity of implementation of a mental health program model, J Consult Clin Psychol, 62, 670, 10.1037/0022-006X.62.4.670 · DOI
  84. McHugo, 1999, Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study, Psychiatr Serv, 50, 818, 10.1176/ps.50.6.818 · DOI
  85. Bond, 2020, Assessing the fidelity of evidence-based practices: history and current status of a standardized measurement methodology, Adm Policy Ment Health, 47, 874, 10.1007/s10488-019-00991-6 · DOI

Metadata

Authors
Fixsen, D. L.
Corresponding author
Fixsen, Dean L.
ORCID
Fixsen, Dean L.
Venue
Frontiers in Health Services
Publisher
Frontiers Media SA
Published
2025-04-25
Volume
5
Pages
1575179-1575179
ISSN
2813-0146 (ISSN-L)
DOI
10.3389/frhs.2025.1575179
PMC
PMC12061988
OpenAlex
W4409825042
Cited by
19
References
12
Citations by year
2026: 15 · 2025: 4
FWCI
18.10
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Health Services (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
  • Social Sciences › Public Administration › Evaluation and Performance Assessment
Keywords
fidelity assessment, implementation, evidence-based innovation, essential components

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