To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education

Louise Schinckus, Stephan Van den Broucke, Gerard van der Zanden, Diane Levin-Zamir, Gabriele Mueller, Henna Riemenschneider, Victoria Hayter, Lucy Yardley, Dean Schillinger, Gerardine Doyle, Kristin Ganahl, Jürgen Pelikan and Peter Chang
Additional contact information
Louise Schinckus: Centre Hospitalier Universitaire Brugmann, 1020 Brussels, Belgium
Stephan Van den Broucke: Psychological Sciences Research Institute, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
Gerard van der Zanden: Psychological Sciences Research Institute, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
Diane Levin-Zamir: School of Public Health, University of Haifa and Clalit Health Services, Tel Aviv 62098, Israel
Gabriele Mueller: Faculty of Medicine Carl Gustav Carus, University Hospital Dresden, Technische Universität Dresden, 01307 Dresden, Germany
Henna Riemenschneider: Faculty of Medicine Carl Gustav Carus, University Hospital Dresden, Technische Universität Dresden, 01307 Dresden, Germany
Victoria Hayter: Centre for Clinical and Community Applications of Health Psychology, University of Southampton, High Field, Southampton SO17 1BJ, UK
Lucy Yardley: Centre for Clinical and Community Applications of Health Psychology, University of Southampton, High Field, Southampton SO17 1BJ, UK
Dean Schillinger: Department of Medicine, University of California at San Francisco, UCSF Box 1364, San Francisco, CA 94110, USA
Gerardine Doyle: College of Business and Geary Institute for Public Policy, University College Dublin, D04 V1W8 Dublin, Ireland
Kristin Ganahl: AKS Gesundheit GmbH, 6900 Bregenz, Austria
Jürgen Pelikan: Gesundheit Österreich GmbH (GÖG), 1010 Wien, Austria
Peter Chang: Department of Occupational Medicine, Chang Bing Show Chwan Memorial Hospital, Lukang, Changhua 505, Taiwan and Department of Medicine, Chung Shan Medical University, Taichung City 40201, Taiwan

IJERPH, 2021, vol. 18, issue 8, 1-15

Abstract: Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME programs on program effectiveness, exploring which factors influence implementation fidelity. Data from 33 type 2 diabetes SME program providers and 166 patients were collected in 8 countries (Austria, Belgium, Germany, Ireland, UK, Israel, Taiwan and USA). Program providers completed a questionnaire assessing their adherence to the program protocol and factors that influenced the implementation. Patients answered a pre–post questionnaire assessing their diabetes-related health literacy, self-care behavior, general health and well-being. Associations between implementation fidelity and outcomes were estimated through logistic regressions and repeated measures MANOVA, controlling for potential confounders. Adaptations of the program protocol regarding content, duration, frequency and/or coverage were reported by 39% of the providers and were associated with better, not worse, outcomes than strict adherence. None of the factors related to the participants, facilitating strategies, provider or context systematically influenced the implementation fidelity. Future research should focus on individual and contextual factors that may influence decisions to adapt SME programs for diabetes.

Keywords: diabetes; self-management education; implementation fidelity; adherence; adaptation; intervention effectiveness (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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