Commentary: Challenges and Opportunites in the Assessment of Fidelity and Related Constructs
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COMMENTARY
Commentary: Challenges and Opportunites in the Assessment of Fidelity and Related Constructs Shannon Wiltsey Stirman1
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Keywords Implementation · Fidelity · Adaptation
Introduction In this special issue, Bond and Drake (2019) capture some of the key challenges and considerations in evaluation of these measures. It is laudable that this issue focuses on a careful evaluation of the psychometric properties of fidelity measures, as many have not been closely evaluated. Fidelity is considered an implementation outcome, but it may also influence clinical outcomes. As such, fidelity measures have been developed and used in intervention process and outcome research, but the psychometric properties of many have not been examined closely. Reliable, valid measurement is critical to establishing what levels of fidelity are needed both to consider a program fully implemented, to understand factors that are necessary and sufficient for desired outcomes (Ruud et al. 2020a). While it is relatively easy to describe high, moderate, and low fidelity based on presence or absence of specific elements or on the quality of what was provided, it is more challenging to establish what specific elements, doses of exposure, and level of fidelity are sufficient to produce the outcomes we seek. It may also be important to distinguish between programs and interventions, while recognizing that nested within each are numerous specific factors that must be assessed. Many components are nested within a broader program or intervention, and often the elements that are most essential have not been empirically established. Determination of associations between intervention outcomes and intervention fidelity (to specific components or the entire intervention) requires careful measurement at multiple timepoints (Webb et al. 2010), something that is not always feasible in routine care settings. * Shannon Wiltsey Stirman [email protected] 1
National Center for PTSD and Stanford University, 795 Willow Rd, NC‑PTSD, Menlo Park, CA 94025, USA
Furthermore, in these contexts, it is challenging to isolate or experimentally manipulate specific elements of the program.
Levels of Fidelity Fidelity to Program Characteristics. Programs comprise multiple components, and require fidelity measures to assess the presence of each of these elements. Such measures tend to assess the degree to which each component is in place, and the concept of adherence or extensiveness may be more central for programs than quality or competence. For example, presence or absence of key staff members, policies, or activities indicates whether these aspects of the program have been implemented as intended. In some programs, one or more specific intervention (e.g., Dialectical Behavior Therapy skills group, Seeking Safety) is a nested within the program. For example, in Illness Management and Recovery (Egeland et al. 2019), cognitive behavioral techniqu
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