title: Applying a fidelity framework to understand adaptations in an occupational health intervention.
abstract: BACKGROUND
  Two objectives are central when implementing occupational health interventions: high intervention fidelity, i.e. alignment with existing theory/evidence, and the need for fit, i.e., matching organizational and employee needs. These objectives can be contradictory and there is little advice on how to successfully combine them.
  
  
  OBJECTIVE
  This study examines if an implementation fidelity framework can be used to categorize and describe how to adapt an occupational health intervention.
  
  
  METHODS
  Using an adapted version of the Conceptual Framework for Implementation Fidelity, we analyzed the implementation of a workplace-based physical exercise intervention and its contextualized adaptations. Adaptations are described in terms of content, dose, coverage and timeliness, each on three levels: individual, unit and organizational. Data sources include systematic project documentation and reflexive discussions.
  
  
  RESULTS
  The intervention was adapted across all aspects and levels of fidelity. Adaptations involved aligning the intervention with level characteristics: organizational level adaptations aligned health policies with cost/benefits, whereas unit level adaptations minimized interference with production and coordinated the intervention with employee preferences. On the individual level, the exercise type varied, which aligned individual needs with the intervention.
  
  
  CONCLUSIONS
  The Conceptual Framework for Implementation Fidelity can help describe the balance between adaptation and adherence at different organizational levels.
authors.affiliation: Department of Psychology, Stockholm University, Stockholm, Sweden.|Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ulrica
authors.initials: U
authors.lastname: von Thiele Schwarz
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Henna
authors.initials: H
authors.lastname: Hasson
authors.affiliation: Department of Psychology, Stockholm University, Stockholm, Sweden.
authors.forename: Petra
authors.initials: P
authors.lastname: Lindfors
mesh_terms: D003258:Consumer Behavior; D003362:Cost-Benefit Analysis; D015444:Exercise; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D016272:Occupational Health; D016134:Organizational Policy; D016730:Program Development; D015397:Program Evaluation; D017132:Workplace / Q000458:organization & administration
keywords: Physical exercise; Tailored interventions; adherence; fidelity; occupational safety and health; physical activity; program theory; workplace - based intervention