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Table 2 Nine elements of intervention fidelity adapted from Hasson et al. [7]

From: Qualitative research to inform hypothesis testing for fidelity-based sub-group analysis in clinical trials: lessons learnt from the process evaluation of a multifaceted podiatry intervention for falls prevention

Element of implementation fidelityDescription
AdherenceWhether an intervention is being delivered as intended
Exposure or doseWhether the amount of an intervention received by participants (frequency and duration) is intended
Quality of deliveryThe way that those responsible for delivering the intervention deliver it
Participant responsivenessHow far participants respond to, or are engaged by, an intervention
Program differentiationIdentifying unique features of different components of programs and identifying which elements are essential
Intervention complexityComplexity of an idea can act as a barrier to adoption - how complex is the intervention?
Facilitation strategiesWhen aiming to evaluate implementation fidelity, what are the specific strategies put in place to support implementation, e.g. provision of manuals, training and incentives. How were these strategies perceived by those involved in delivery?
• RecruitmentThe recruitment strategies used to attract individuals to the intervention – what are the challenges to involvement?
• ContextWhat factors at political, economic, organisational and work group levels affected implementation?
  1. • Denotes new moderating factors for understanding fidelity