Implementation fidelity

What is implementation fidelity?

Implementation fidelity refers to the degree to which an intervention is delivered as intended. It is looking at the implementation of interventions in practice. Often interventions are designed in a specific situation and addressing the issues which are typical for this situation. An intervention that has proven to be effective in one context may not be working as expected when applying it in another context.

In order to avoid failure, it is important to analyse exactly what are the factors that contribute to successful implementation:

  • It is of key importance to be aware of the conditions and circumstances under which an intervention can be implemented successfully. Main components are:
    • Adherence: The degree to which interventions are delivered as intended (find more information here).
    • Exposure: Number and lengths of sessions implemented, frequency of implementation of programme techniques.
    • Quality of programme delivery: Manner in which an intervention is delivered.
    • Participant responsiveness: Extent to which participants are involved in the content of an intervention.
    • Recruitment strategy: Procedures that are used to attract potential program participants.
    • Context: Surrounding social systems such as structures or cultures of groups (find more information here).
  • Make sure that the intervention is feasible in the local context and assess potential barriers to its implementation.
  • Advocate co-creation of interventions whereby end-users can formulate the activities, play a role in management and in performance monitoring.
  • Support the implementation of an intervention through training and technical assistance.
  • To enable a structured evaluation of the implementation process it might be helpful to use a theoretical framework.

A theoretical framework for implementation fidelity

Based on a model from Carroll et al., Hasson (2010) has developed a modified theoretical framework that shows the relationship between the intervention, adherence, outcomes and moderators. A process evaluation might be more successful if it includes all aspects of this framework.


It is important to understand and agree what fidelity of implementation entails and how it can be measured. There is a need for easy-to-use measures to assess the core elements of implementation fidelity. This can facilitate the monitoring of the implementation of an intervention and can also offer the possibility to compare the implementation fidelity of different interventions.

How to improve fidelity by empowerment implementation?

According to an empowerment implementation approach (as described by Van Daele 2012), an intervention consists of two parts: a core component and less important intervention aspects. The core component may not be changed while researchers and local partners are free to decide on less important intervention aspects.

The empowerment implementation approach is thus based on four main steps:

  • development of a core component;

  • selection of partners;

  • assessment of fidelity/adaptation concerns with partners;

  • development of an overall implementation plan.

The empowerment implementation approach offers the possibility to include partner input and variability. This gives local partners the chance to adapt an intervention to their needs and can enhance their ownership of an intervention.


Van den Branden S., Van den Broucke S., Leroy R., Declerck D., Hoppenbrouwers K. (2013) Evaluating the Implementation Fidelity of a Multicomponent Intervention for Oral Health Promotion in Preschool Children. Society for Prevention Research DOI: 10.1007/s11121-013-0425-3.

Van Daele T., Van Audenhove C., Hermans D., Van Den Bergh O., Van Den Broucke S. (2012) Empowerment implementation: enhancing fidelity and adaptation in a psycho-educational intervention. Health Promotion International DOI: 10.1093/heapro/das070

Hasson (2010) Systematic evaluation of implementation fidelity of complex interventions in health and social care. Implementation Science 5:67 DOI: 10.1186/1748-5908-5-67. Download PDF here

Kilbourne , Neumann M., Pincus H., Bauer M., Stall R. (2007) Implementing evidence-based interventions in healthcare: application of the replicating effective programs framework. Implementation Science, 2:42 DOI:10.1186/1748-5908-2-42. Download PDF here

Schinckus L., Van den Broucke S., Housiaux M. (2014). Implementation Fidelity of Diabetes Self-management Education Programs: A Systematic Review. In: Patient Education and Counseling, Vol. 96, no. 1, p. 13-21 DOI:10.1016/j.pec.2014.04.002.




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