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.
