To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education.
Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME programs on program effectiveness, exploring which factors influence implementation fidelity. Data from 33 type 2 diabetes SME program providers and 166 patients were collected in 8 countries (Austria, Belgium, Germany, Ireland, UK, Israel, Taiwan and USA). Program providers completed a questionnaire assessing their adherence to the program protocol and factors that influenced the implementation. Patients answered a pre-post questionnaire assessing their diabetes-related health literacy, self-care behavior, general health and well-being. Associations between implementation fidelity and outcomes were estimated through logistic regressions and repeated measures MANOVA, controlling for potential confounders. Adaptations of the program protocol regarding content, duration, frequency and/or coverage were reported by 39% of the providers and were associated with better, not worse, outcomes than strict adherence. None of the factors related to the participants, facilitating strategies, provider or context systematically influenced the implementation fidelity. Future research should focus on individual and contextual factors that may influence decisions to adapt SME programs for diabetes.
['Schinckus|Louise|L|', 'Van den Broucke|Stephan|S|', 'van der Zanden|Gerard|G|', 'Levin-Zamir|Diane|D|', 'Mueller|Gabriele|G|', 'Riemenschneider|Henna|H|', 'Hayter|Victoria|V|0000-0002-2157-2855', 'Yardley|Lucy|L|', 'Schillinger|Dean|D|', 'Doyle|Gerardine|G|0000-0001-8516-4431', 'Ganahl|Kristin|K|0000-0001-7322-6754', 'Pelikan|Jürgen|J|', 'Chang|Peter|P|0000-0001-6651-3624']
D001317:Austria D001530:Belgium D003924:Diabetes Mellitus, Type 2 D005858:Germany D006801:Humans D007494:Ireland D007557:Israel D015397:Program Evaluation D000073278:Self-Management D013624:Taiwan
adaptation implementation fidelity diabetes self-management education adherence intervention effectiveness