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Applying a fidelity framework to understand adaptations in an occupational health intervention.

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.