An Exploration of Fidelity of Implementation in Drug Abuse Prevention among Five Professional Groups
Dusenbury, Linda, Brannigan, Rosalind, Falco, Mathea, Lake, Antonia, Journal of Alcohol & Drug Education
To explore the extent of awareness among practitioners of the importance of fidelity of implementation and the factors that inhibit or encourage it, interviews were conducted with nine individuals in each of the following groups: 1) researchers who have developed and evaluated prevention curricula; 2)publishers of drug abuse prevention curricula; 3) school administrators; 4) teachers; and 5) State Safe Drug Free Schools Coordinators. Interviews with leading researchers found there is inconsistency in definition as well as a lack of standard measures and methodology to investigate fidelity. All of the groups agreed that training was critically important to fidelity of implementation. Strategies for promoting fidelity of implementation are discussed.
Fidelity of implementation refers to the degree to which teachers and other program providers implement programs as intended by the program developers. Unfortunately, as Berman and McLaughlin (1976) observe, while "the bridge between a promising idea and its impact on students is implementation," ... "innovations are seldom implemented as planned." (p.349).
In the field of drug abuse prevention, numerous research-based programs are delivered in schools by regular classroom teacher (Drug Strategies, 1999). However, there have been increasing reports that the quality of implementation of these programs is varied. In many studies, high fidelity of implementation has been associated with improved student outcomes (Abbot, et al., 1998; Battistich, Schaps, Watson, & Solomon, 1996; Botvin, Dusenbury, Tortu, & Botvin, 1990; Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995). In the prevention literature, most researchers view any changes in a program as a potential threat to the integrity of the intervention, and most research has supported the expectation that the more completely a teacher implements a program, the less likely students will use drugs (Botvin, Baker, Dusenbury, Botvin, & Tortu, 1990; Rohrbach, Graham, & Hansen, 1993; Resnicow, Cross, & Wynder, 1993). The inverse also has been shown to be true: When programs are not implemented as intended, they are less likely to be effective. In addition, fidelity of implementation has been associated with changes in mediating variables believed to be responsible for outcomes (Hansen, Graham, Wolkenstein, & Rohrbach, 1991).
The few studies that have assessed fidelity of implementation find that it is seldom achieved. Good evaluations of drug abuse prevention programs have been done in the context of rigorous field trials, where there is considerable effort to get teachers to implement programs exactly as intended. However, even under these circumstances, research suggests that there is tremendous variability in how consistently different teachers present program material (Botvin, et al., 1990; Tortu & Botvin, 1989; Pentz, et al., 1990; Tappe, Galer-Unti, & Bailey, 1995).
To explore the extent of awareness among practitioners of the importance of fidelity of implementation and the factors that inhibit or encourage it, interviews were conducted with nine individuals in each of the following groups: 1) researchers who have developed and evaluated prevention curricula; 2) program developers/publishers of drug abuse prevention curricula; 3) school administrators who have selected and purchased prevention curricula; 4) teachers who have implemented prevention programs; and 5) State Safe and Drug Free Schools Coordinators who are responsible for overseeing the implementation of a wide range of programs in diverse settings.
Telephone interviews were conducted with five separate professional groups: 1) nationally recognized researchers actively studying prevention programs effectiveness; 2) drug abuse prevention program developers; 3) school administrators involved in the selection and implementation of programs; 4) teachers responsible for delivering prevention programs; and 5) Safe and Drug Free School Coordinators in states with a wide dissemination of prevention programs. …