title: Balancing "fidelity" and community context in the adaptation of asthma evidence-based interventions in the "real world".
abstract: The Merck Childhood Asthma Network (MCAN) initiative selected five sites (New York City, Puerto Rico, Chicago, Los Angeles, and Philadelphia) to engage in translational research to adapt evidence-based interventions (EBIs) to improve childhood asthma outcomes. The authors summarize the sites' experience by describing criteria defining the fidelity of translation, community contextual factors serving as barriers or enablers to fidelity, types of adaptation conducted, and strategies used to balance contextual factors and fidelity in developing a "best fit" for EBIs in the community. A conceptual model captures important structural and process-related factors and helps frame lessons learned. Site implementers and intervention developers reached consensus on qualitative rankings of the levels of fidelity of implementation for each of the EBI core components: low fidelity, adaptation (major vs. minor), or high fidelity. MCAN sites were successful in adapting core EBI components based on their understanding of structural and other contextual barriers and enhancers in their communities. Although the sites varied regarding both the EBI components they implemented and their respective levels of fidelity, all sites observed improvement in asthma outcomes. Our collective experiences of adapting and implementing asthma EBIs highlight many of the factors affecting translation of evidenced-based approaches to chronic disease management in real community settings.
authors: RAND Health, Santa Monica, CA, USA.
authors: Marielena
authors: M
authors: Lara
authors: Tyra
authors: T
authors: Bryant-Stephens
authors: Maureen
authors: M
authors: Damitz
authors: Sally
authors: S
authors: Findley
authors: Jesús González
authors: JG
authors: Gavillán
authors: Herman
authors: H
authors: Mitchell
authors: Yvonne U
authors: YU
authors: Ohadike
authors: Victoria W
authors: VW
authors: Persky
authors: Gilberto Ramos
authors: GR
authors: Valencia
authors: Lucia Rojas
authors: LR
authors: Smith
authors: Michael
authors: M
authors: Rosenthal
authors: Shannon
authors: S
authors: Thyne
authors: Kimberly
authors: K
authors: Uyeda
authors: Meera
authors: M
authors: Viswanathan
authors: Carol
authors: C
authors: Woodell
mesh_terms: D001249:Asthma / Q000188:drug therapy; D002648:Child; D019058:Community Networks / Q000458:organization & administration*; D004059:Diffusion of Innovation; D019468:Disease Management; D055317:Evidence-Based Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D011647:Puerto Rico; D012648:Self Care; D014481:United States; D014505:Urban Population