Implementation fidelity trajectories of a health promotion program in multidisciplinary settings: managing tensions in rehabilitation care

摘要: Although the importance of evaluating implementation fidelity is acknowledged, little known about heterogeneity in over time. This study aims to generate insight into trajectories a health promotion program multidisciplinary settings and relationship with changes patients’ behavior. used longitudinal data from nationwide an evidence-informed physical activity Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled by involved professionals (n = ± 70). Higher indicate more complete program’s core components. A hierarchical cluster analysis was conducted 17 organizations at three different time points. Quantitative qualitative explore organizational professional differences between identified trajectories. Regression analyses determine patient outcomes. Three as following: ‘stable high fidelity’ (n = 9), ‘moderate improving (n = 6), ‘unstable (n = 2). The stable generally smaller, started earlier, implemented structured way compared moderate organizations. At period’s start end, support physicians physiotherapists, professionals’ appreciation, compatibility rated positively working (p < .05). Qualitative showed that had often explicit vision strategy program. Intriguingly, not associated self-reported outcomes (adjusted model β = − 651.6, t(613) = − 1032, p = .303). Differences organizational-level did result outcome patient-level. suggests effective trajectory contingent local organization’s conditions. More specifically, achieving required management tensions: realizing localized change vision, while safeguarding standardized components engaging scarce throughout process. When scaling up programs, we propose tailor tensions organizations’ starting position, size, circumstances. Netherlands National Trial Register NTR3961 . Registered 18 April 2013.