Next Article in Journal
Effect of a Preventive Oral Health Program Starting during Pregnancy: A Case-Control Study Comparing Immigrant and Native Women and Their Children
Previous Article in Journal
Measuring Nature Contact: A Narrative Review
Article

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

1
Centre Hospitalier Universitaire Brugmann, 1020 Brussels, Belgium
2
Psychological Sciences Research Institute, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
3
School of Public Health, University of Haifa and Clalit Health Services, Tel Aviv 62098, Israel
4
Faculty of Medicine Carl Gustav Carus, University Hospital Dresden, Technische Universität Dresden, 01307 Dresden, Germany
5
Centre for Clinical and Community Applications of Health Psychology, University of Southampton, High Field, Southampton SO17 1BJ, UK
6
Department of Medicine, University of California at San Francisco, UCSF Box 1364, San Francisco, CA 94110, USA
7
College of Business and Geary Institute for Public Policy, University College Dublin, D04 V1W8 Dublin, Ireland
8
AKS Gesundheit GmbH, 6900 Bregenz, Austria
9
Gesundheit Österreich GmbH (GÖG), 1010 Wien, Austria
10
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
*
Author to whom correspondence should be addressed.
Academic Editors: Monique Heijmans and Carola Orrego
Int. J. Environ. Res. Public Health 2021, 18(8), 4095; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084095
Received: 26 January 2021 / Revised: 30 March 2021 / Accepted: 7 April 2021 / Published: 13 April 2021
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. View Full-Text
Keywords: diabetes; self-management education; implementation fidelity; adherence; adaptation; intervention effectiveness diabetes; self-management education; implementation fidelity; adherence; adaptation; intervention effectiveness
MDPI and ACS Style

Schinckus, L.; Van den Broucke, S.; van der Zanden, G.; Levin-Zamir, D.; Mueller, G.; Riemenschneider, H.; Hayter, V.; Yardley, L.; Schillinger, D.; Doyle, G.; Ganahl, K.; Pelikan, J.; Chang, P. To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education. Int. J. Environ. Res. Public Health 2021, 18, 4095. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084095

AMA Style

Schinckus L, Van den Broucke S, van der Zanden G, Levin-Zamir D, Mueller G, Riemenschneider H, Hayter V, Yardley L, Schillinger D, Doyle G, Ganahl K, Pelikan J, Chang P. To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education. International Journal of Environmental Research and Public Health. 2021; 18(8):4095. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084095

Chicago/Turabian Style

Schinckus, Louise, 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. 2021. "To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education" International Journal of Environmental Research and Public Health 18, no. 8: 4095. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084095

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop