Investigating Variations in Implementation Fidelity of an Organizational-Level Occupational Health Intervention
Investigating Variations in Implementation Fidelity of an Organizational-Level Occupational Health Intervention
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DOI：
10.1007/s12529-014-9420-8
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发表时间：
2015-06-01
影响因子：
2.7
通讯作者：
Hasson, Henna
中科院分区：
文献类型：
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作者：
Augustsson, Hanna;Schwarz, Ulrica von Thiele;Hasson, Henna
工作场所被认为是健康促进的重要竞技场，但对组织环境如何影响干预措施的实施知之甚少。本研究的目的是评估组织层面职业健康干预措施的实施忠诚度，并探讨干预单位之间忠诚度差异的可能解释。干预措施包括健康促进，职业健康和安全，以及持续改进（Kaizen）系统，并在瑞典一家医院进行了准实验设计。实施保真度进行了评估与实施保真度的概念框架和实施因素，用于调查保真度的变化与评估国家层面的干预措施的框架。多方法的方法，包括访谈，Kaizen笔记，和问卷调查applied.Implementation保真度不同的单位，即使干预的介绍和支持以同样的方式。评价组织一级干预措施的模式中提出的所有要素的重要差异，即，背景，干预和心理模型，被发现可以解释忠诚度的差异。实施策略可能需要根据当地情况进行调整。实施保真度，以及干预前的实施要素，可能会影响实施的成功，需要在干预研究进行评估。各单位的保真度差异很大，表明需要调整用于评估干预措施效果的设计类型。因此，与其使用旨在控制变异的设计，还不如使用旨在探索和解释变异的设计，如适应性研究设计。
The workplace has been suggested as an important arena for health promotion, but little is known about how the organizational setting influences the implementation of interventions.The aims of this study are to evaluate implementation fidelity in an organizational-level occupational health intervention and to investigate possible explanations for variations in fidelity between intervention units.The intervention consisted of an integration of health promotion, occupational health and safety, and a system for continuous improvements (Kaizen) and was conducted in a quasi-experimental design at a Swedish hospital. Implementation fidelity was evaluated with the Conceptual Framework for Implementation Fidelity and implementation factors used to investigate variations in fidelity with the Framework for Evaluating Organizational-level Interventions. A multi-method approach including interviews, Kaizen notes, and questionnaires was applied.Implementation fidelity differed between units even though the intervention was introduced and supported in the same way. Important differences in all elements proposed in the model for evaluating organizational-level interventions, i.e., context, intervention, and mental models, were found to explain the differences in fidelity.Implementation strategies may need to be adapted depending on the local context. Implementation fidelity, as well as pre-intervention implementation elements, is likely to affect the implementation success and needs to be assessed in intervention research. The high variation in fidelity across the units indicates the need for adjustments to the type of designs used to assess the effects of interventions. Thus, rather than using designs that aim to control variation, it may be necessary to use those that aim at exploring and explaining variation, such as adapted study designs.