title: Factors contributing to intervention fidelity in a multi-site chronic disease self-management program.
abstract: OBJECTIVE
  Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design.
  
  
  METHODS
  The Florida Health Literacy Study (FHLS) was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance.
  
  
  RESULTS
  This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation.
  
  
  CONCLUSIONS
  Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.
authors.affiliation: College of Public Health, University of South Florida, Tampa, Florida, USA. kperrin@health.usf.edu
authors.forename: Karen M
authors.initials: KM
authors.lastname: Perrin
authors.forename: Somer Goad
authors.initials: SG
authors.lastname: Burke
authors.forename: Danielle
authors.initials: D
authors.lastname: O'Connor
authors.forename: Gary
authors.initials: G
authors.lastname: Walby
authors.forename: Claire
authors.initials: C
authors.lastname: Shippey
authors.forename: Seraphine
authors.initials: S
authors.lastname: Pitt
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McDermott
authors.forename: Melinda S
authors.initials: MS
authors.lastname: Forthofer