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Table 1 Definitions of subcomponents that represent dimensions suggested in the literature that fidelity and adaptation can refer toa

From: The Value Equation: Three complementary propositions for reconciling fidelity and adaptation in evidence-based practice implementation

Sub-componentsCharacteristics of the interventionCharacteristics of the context of delivery
Content of intervention
What intervention activities and processes are performed? [4, 37]
Intervention delivery
How is the intervention delivered? [2, 37]
In which format and through which channels is the intervention delivered? [13, 24]
Conditions of the delivery context
What are the precise conditions related to the system, organization and providers under which the intervention is delivered? [38]
What is the target population specifics? [7]
Suggested dimensions to consider• The intervention core components, the specific active ingredients that make an EBI effective [7], fidelity consistent components [39]
• The logic or theory that explains how the intervention is intended to work (i.e. the interventions’ deep structure [40], intervention strength [38] and program model [7]; its function [41])
• Components that are part of the intervention but not central for producing the outcomes (surface structure) [40] or adaptable periphery
• Components, not part of the intervention: fidelity consistent [5, 7, 39], or fidelity inconsistent [39]
• Components that make the intervention uniquely distinguishable (program differentiation) [2]
• Number, length and frequency of sessions,
• Density: how the intervention is spaced out in time; the intensity of the intervention [28]
• The quality of delivery [2, 4]
• What the treatment provider plans and believes is delivered (dose delivered)
• What the recipient perceives that they have received (dose received) [42]
• The timing; when the various parts of the intervention is delivered in relation to the other parts [43]
• Format of delivery, e.g. one-to-one or group
• Channels of delivery, e.g. phone, internet or face-to-face
• Location of delivery, e.g. school, non-profit organization or church
• Interventionist specifics (e.g. who is delivering the intervention; their training, competence level; personal attributes and skills)
• Setting, e.g. primary care, hospital, community-based, workplace-based [13]
• Organizational factors, e.g. climate, leadership, mandate, history [44]
• System characteristics, e.g. reimbursement models, contracts, laws, policies, regulations, political climate [44]
• The health conditions that the intervention targets
• Cultural characteristics
• Age groups (e.g., children, youth, adults)
• Patient’s own health goals and specific needs
• Comorbidities
  1. aFidelity and adaptation sometimes refer to implementation strategies rather than interventions, that is, to what extent the strategies chosen to facilitate the use of the intervention is adhered to or adapted. The focus of the current paper is on fidelity to and adaptations of interventions