Evaluating Fidelity Frameworks in Health Interventions: A Scoping Review of Conceptual,Implementation,and Adaptation Models

Abstract

This scoping review aimed to map fidelity-related frameworks used to design, implement, and evaluate health interventions from 2015 to 2025. Despite the growing recognition of fidelity as critical for intervention effectiveness, no prior synthesis had examined which conceptual, implementation, or adaptation frameworks are employed or how they differ. A systematic search across five databases identified 520 eligible studies. Seventeen frameworks were categorized: six conceptual, seven implementation, and four adaptation-focused. Implementation frameworks predominated (59%), led by Reach, Effectiveness, Adoption, Implementation, Maintenance framework and Consolidated Framework for Implementation Research. Conceptual Framework of Implementation Fidelity was most used among conceptual models, while adaptation-oriented frameworks such as UK Medical Research Council guidance, integrated-PARIHS, and FRAME accounted for 19% of studies. Comparative analysis revealed key gaps—no framework adequately integrated fidelity, adaptation, context, and sustainability. This review offers a structured comparison and decision aid for selecting frameworks aligned with implementation goals. It calls for integrative models that support fidelity monitoring while enabling context-appropriate adaptation across diverse health settings.