Implementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES project

dc.contributor.authorSaarijärvi, Markus
dc.contributor.authorWallin, Lars
dc.contributor.authorMoons, Philip
dc.contributor.authorGyllensten, Hanna
dc.contributor.authorBratt, Ewa-Lena
dc.date.accessioned2022-04-08T11:11:29Z
dc.date.available2022-04-08T11:11:29Z
dc.date.issued2022-02-05
dc.date.updated2022-02-06T04:12:47Z
dc.description.abstractBackground Although transition programs have been evaluated for adolescents with chronic conditions, these have rarely involved process evaluations. Indeed, outcomes of complex interventions are dependent on how the intervention is implemented in practice and evaluations of implementation process are therefore pivotal. The aim of this study was to evaluate the extent to which a transition program for adolescents with congenital heart disease was delivered as intended. Research questions were 1) to what level of fidelity was the program delivered? and 2) what potential moderating factors affected the delivery of the program and overall fidelity? Methods A mixed methods design was used, where a process evaluation was embedded in the STEPSTONES randomized controlled trial in Sweden. The implementation fidelity framework by Carrol (2007) and Hasson (2010) was used to design, collect and analyze data. Quantitative data consisted of intervention records on adherence and were analyzed with descriptive statistics. Qualitative data on moderators affecting fidelity were collected through interviews, log-books and focus group interviews with healthcare professionals implementing the intervention and participatory observations of the implementation process. Data were analyzed with deductive content analysis. Triangulation was used to integrate quantitative and qualitative data within the fidelity framework. Results Six out of eight components of the transition program were delivered to an extent that adhered to the program theory or achieved a high level of fidelity. However, components involving peer support had a low attendance by the participating sample (32.2%), and the joint transfer meeting was challenging to implement, despite achieving high adherence. Moderators affecting the implementation process were the adolescent’s and healthcare professional’s engagement in the intervention, contextual factors and a lack of standard operating procedures for all components in the program. Conclusion Barriers and facilitators for a future implementation of transition programs have been illuminated in this study. The use of an implementation fidelity framework in the process evaluation proved successful in providing a comprehensive evaluation of factors affecting the implementation process. However, implementation fidelity must be considered in relation to adaptations to the local and personal prerequisites in order to create interventions that can achieve fit.en_US
dc.identifier.apacitationSaarijärvi, M., Wallin, L., Moons, P., Gyllensten, H., & Bratt, E. (2022). Implementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES project. <i>BMC Health Services Research</i>, 22(1), 153. http://hdl.handle.net/11427/36305en_ZA
dc.identifier.chicagocitationSaarijärvi, Markus, Lars Wallin, Philip Moons, Hanna Gyllensten, and Ewa-Lena Bratt "Implementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES project." <i>BMC Health Services Research</i> 22, 1. (2022): 153. http://hdl.handle.net/11427/36305en_ZA
dc.identifier.citationSaarijärvi, M., Wallin, L., Moons, P., Gyllensten, H. & Bratt, E. 2022. Implementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES project. <i>BMC Health Services Research.</i> 22(1):153. http://hdl.handle.net/11427/36305en_ZA
dc.identifier.ris TY - Journal Article AU - Saarijärvi, Markus AU - Wallin, Lars AU - Moons, Philip AU - Gyllensten, Hanna AU - Bratt, Ewa-Lena AB - Background Although transition programs have been evaluated for adolescents with chronic conditions, these have rarely involved process evaluations. Indeed, outcomes of complex interventions are dependent on how the intervention is implemented in practice and evaluations of implementation process are therefore pivotal. The aim of this study was to evaluate the extent to which a transition program for adolescents with congenital heart disease was delivered as intended. Research questions were 1) to what level of fidelity was the program delivered? and 2) what potential moderating factors affected the delivery of the program and overall fidelity? Methods A mixed methods design was used, where a process evaluation was embedded in the STEPSTONES randomized controlled trial in Sweden. The implementation fidelity framework by Carrol (2007) and Hasson (2010) was used to design, collect and analyze data. Quantitative data consisted of intervention records on adherence and were analyzed with descriptive statistics. Qualitative data on moderators affecting fidelity were collected through interviews, log-books and focus group interviews with healthcare professionals implementing the intervention and participatory observations of the implementation process. Data were analyzed with deductive content analysis. Triangulation was used to integrate quantitative and qualitative data within the fidelity framework. Results Six out of eight components of the transition program were delivered to an extent that adhered to the program theory or achieved a high level of fidelity. However, components involving peer support had a low attendance by the participating sample (32.2%), and the joint transfer meeting was challenging to implement, despite achieving high adherence. Moderators affecting the implementation process were the adolescent’s and healthcare professional’s engagement in the intervention, contextual factors and a lack of standard operating procedures for all components in the program. Conclusion Barriers and facilitators for a future implementation of transition programs have been illuminated in this study. The use of an implementation fidelity framework in the process evaluation proved successful in providing a comprehensive evaluation of factors affecting the implementation process. However, implementation fidelity must be considered in relation to adaptations to the local and personal prerequisites in order to create interventions that can achieve fit. DA - 2022-02-05 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Health Services Research KW - Adolescent KW - Heart defect; congenital KW - Chronic disease KW - Implementation fidelity KW - Mixed methods KW - Process evaluation KW - Randomized controlled trial KW - Transition of care LK - https://open.uct.ac.za PY - 2022 T1 - Implementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES project TI - Implementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES project UR - http://hdl.handle.net/11427/36305 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12913-022-07549-7
dc.identifier.urihttp://hdl.handle.net/11427/36305
dc.identifier.vancouvercitationSaarijärvi M, Wallin L, Moons P, Gyllensten H, Bratt E. Implementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES project. BMC Health Services Research. 2022;22(1):153. http://hdl.handle.net/11427/36305.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentDepartment of Paediatrics and Child Healthen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceBMC Health Services Researchen_US
dc.source.journalissue1en_US
dc.source.journalvolume22en_US
dc.source.pagination153en_US
dc.source.urihttps://bmchealthservres.biomedcentral.com/
dc.subjectAdolescenten_US
dc.subjectHeart defect; congenitalen_US
dc.subjectChronic diseaseen_US
dc.subjectImplementation fidelityen_US
dc.subjectMixed methodsen_US
dc.subjectProcess evaluationen_US
dc.subjectRandomized controlled trialen_US
dc.subjectTransition of careen_US
dc.titleImplementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES projecten_US
dc.typeJournal Articleen_US
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