title: Fiscal loss and program fidelity: impact of the economic downturn on HIV/STI prevention program fidelity.
abstract: The economic downturn of 2007 created significant fiscal losses for public and private agencies conducting behavioral prevention. Such macro-economic changes may influence program implementation and sustainability. We examined how public and private agencies conducting RESPECT, a brief HIV/STI (sexually transmitted infection) counseling and testing intervention, adapted to fiscal loss and how these adaptations impacted program fidelity. We collected qualitative and quantitative data in a national sample of 15 agencies experiencing fiscal loss. Using qualitative analyses, we examined how program fidelity varied with different types of adaptations. Agencies reported three levels of adaptation: agency-level, program-level, and direct fiscal remedies. Private agencies tended to use direct fiscal remedies, which were associated with higher fidelity. Some agency-level adaptations contributed to reductions in procedural fit, leading to negative staff morale and decreased confidence in program effectiveness, which in turn, contributed to poor fidelity. Findings describe a "work stress pathway" that links program fiscal losses to poor staff morale and low program fidelity.
authors.affiliation: Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 2631 SW Campus Way, Corvallis, OR 97330 USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Catania
authors.affiliation: Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 2631 SW Campus Way, Corvallis, OR 97330 USA.
authors.forename: M Margaret
authors.initials: MM
authors.lastname: Dolcini
authors.affiliation: California STD/HIV Prevention Training Center, University of California, San Francisco, CA USA.
authors.forename: Alice A
authors.initials: AA
authors.lastname: Gandelman
authors.affiliation: Westat Corporation, Rockville, MD USA.
authors.forename: Vasudha
authors.initials: V
authors.lastname: Narayanan
authors.affiliation: Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 2631 SW Campus Way, Corvallis, OR 97330 USA.
authors.forename: Virginia R
authors.initials: VR
authors.lastname: McKay
keywords: Adaptions; Economic downturn; Fidelity; Fiscal loss; HIV/STI behavioral prevention; Implementation; Work strain