Fidelity and Adaptation of Programs: Does Adaptation Thwart Effectiveness?

Abstract

Evidence-based programs and grassroots programs are often adapted during implementation. Adaptations are often hidden, ignored, or punished. Although some adaptations stem from lack of organizational capacity, evaluators report other adaptations happen in good faith or are efforts to better fit the local context. Program implementers, facilitators who need to adapt during implementation, do not always report adaptations because they fear losing funding if the program is not implemented with fidelity. Program personnel including program evaluators need this information to improve effectiveness of programs, and to determine whether an adaptation is still consistent with the theory of change. Evaluators also need this information for generalizing results to varied settings and populations. Following the PRECEDE–PROCEED model, we recommend a hybrid approach to fidelity and adaptation. We argue in favor of advance planning to accommodate potential adaptations. Such planning also establishes evaluation criteria for determining whether adaptations are helpful, harmful, and appropriate to the context. We illustrate some types of adaptations that can occur, why they may be needed, and how to structure transparent reporting about adaptations to program developers and funding organizations.