Scholarlink

Background <p>Adolescents and young adults (AYAs) aged 10–24 years in sub-Saharan Africa experience low nutrition literacy and poor diet quality. Community health worker (CHW)-led interventions offer a delivery platform, yet little is known about how implementation proceeds under routine conditions or how fidelity is maintained alongside adaptive delivery adjustments. We assessed implementation fidelity over time and examined how contextual influences and supervision-guided adaptive delivery adjustments shaped delivery processes and supported preservation of core intervention functions during the nine-month implementation of a CHW-led intervention in Uganda.</p> Methods <p>This longitudinal mixed-methods implementation study was nested within a nine-month randomized controlled trial in rural Eastern Uganda. Fidelity was assessed across early, mid, and late implementation using Carroll’s framework. Qualitative data were collected through repeated focus group discussions with CHWs, AYAs, and parents. Data were analysed using an inductive–deductive approach: adaptive delivery processes were identified inductively and organized and interpreted using the Consolidated Framework for Implementation Research. Quantitative and qualitative findings were integrated using joint displays to compare fidelity findings with qualitative contextual influences, supervision, and adaptive delivery adjustments.</p> Results <p>Fidelity scores were high across implementation periods, with modest variation across domains. On a 1–5 scale, overall comparable fidelity scores were 4.18 (SD 0.12), 4.21 (SD 0.07), and 4.16 (SD 0.08) during early, mid, and late implementation, respectively. Adherence remained stable while quality of delivery was slightly higher during mid-implementation. Five adaptive delivery processes were identified: flexible scheduling and revisits; contextualized reinforcement of complex content; resource-sensitive counselling adjustment; workload-responsive micro-planning; and network-supported participant follow-up. Qualitative findings indicated that participant availability, comprehension challenges, household resource constraints, CHW workload, and participant mobility shaped delivery. Supervisory reflection and debrief provided a forum for reviewing challenges, sharing practical solutions, harmonizing delivery practices, and agreeing on context-responsive adjustments. These adjustments modified delivery forms, including visit timing, communication approaches, locally feasible examples, visit sequencing, and follow-up arrangements, while preserving core intervention functions.</p> Conclusion <p>Adaptive delivery and implementation fidelity can be managed as interdependent implementation processes rather than competing priorities. Fidelity monitoring, supportive supervision, and guided problem-solving supported context-responsive delivery adjustments while supporting maintenance of core intervention functions.</p> Trial registrations <p>The parent randomized controlled trial was prospectively registered with the Pan African Clinical Trials Registry (PACTR202406699274475) on 7 June 2024. <a href="https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=30558">https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=30558</a>.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Balancing adaptive delivery and implementation fidelity over time: a longitudinal mixed-methods study of a community health worker–led adolescent nutrition intervention in rural Uganda

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年8月1日

查看全文
  • Thomas Buyinza,
  • Edward Buzigi,
  • Shuyan Liu,
  • Justine Bukenya,
  • Mary Mwanyika Sando,
  • Till Bärnighausen,
  • David Guwatudde,
  • Rawlance Ndejjo

摘要

Background

Adolescents and young adults (AYAs) aged 10–24 years in sub-Saharan Africa experience low nutrition literacy and poor diet quality. Community health worker (CHW)-led interventions offer a delivery platform, yet little is known about how implementation proceeds under routine conditions or how fidelity is maintained alongside adaptive delivery adjustments. We assessed implementation fidelity over time and examined how contextual influences and supervision-guided adaptive delivery adjustments shaped delivery processes and supported preservation of core intervention functions during the nine-month implementation of a CHW-led intervention in Uganda.

Methods

This longitudinal mixed-methods implementation study was nested within a nine-month randomized controlled trial in rural Eastern Uganda. Fidelity was assessed across early, mid, and late implementation using Carroll’s framework. Qualitative data were collected through repeated focus group discussions with CHWs, AYAs, and parents. Data were analysed using an inductive–deductive approach: adaptive delivery processes were identified inductively and organized and interpreted using the Consolidated Framework for Implementation Research. Quantitative and qualitative findings were integrated using joint displays to compare fidelity findings with qualitative contextual influences, supervision, and adaptive delivery adjustments.

Results

Fidelity scores were high across implementation periods, with modest variation across domains. On a 1–5 scale, overall comparable fidelity scores were 4.18 (SD 0.12), 4.21 (SD 0.07), and 4.16 (SD 0.08) during early, mid, and late implementation, respectively. Adherence remained stable while quality of delivery was slightly higher during mid-implementation. Five adaptive delivery processes were identified: flexible scheduling and revisits; contextualized reinforcement of complex content; resource-sensitive counselling adjustment; workload-responsive micro-planning; and network-supported participant follow-up. Qualitative findings indicated that participant availability, comprehension challenges, household resource constraints, CHW workload, and participant mobility shaped delivery. Supervisory reflection and debrief provided a forum for reviewing challenges, sharing practical solutions, harmonizing delivery practices, and agreeing on context-responsive adjustments. These adjustments modified delivery forms, including visit timing, communication approaches, locally feasible examples, visit sequencing, and follow-up arrangements, while preserving core intervention functions.

Conclusion

Adaptive delivery and implementation fidelity can be managed as interdependent implementation processes rather than competing priorities. Fidelity monitoring, supportive supervision, and guided problem-solving supported context-responsive delivery adjustments while supporting maintenance of core intervention functions.

Trial registrations

The parent randomized controlled trial was prospectively registered with the Pan African Clinical Trials Registry (PACTR202406699274475) on 7 June 2024. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=30558.