An Innovative Way to Address the Fidelity-Adaptation Debate: Forms and Functions
By Dr. Julia Moore, Executive Director
6-min read
The adaptation-fidelity debate
When I moved to the US from Canada to do my PhD, there was robust discussion amongst program developers about maintaining fidelity to the program during implementation. Over time, I was exposed to another part of the debate as I heard from program implementers who recognized the need for on-the-ground adaptations. Moving back to Canada and working primarily with implementers, I couldn’t even get into the room without talking about adaptation. The importance of adaptation has become even more emphasized as a result of the COVID-19 pandemic, where adaptation was required to continue to operate services, to promote equity and meet people’s needs.
That often leaves people feeling lost and confused. They are worried about the possibility of letting people adapt so much that the program is no longer effective, but recognize the adaptations are necessary. Implementers want people to be able to adapt, but those supporting implementation (e.g., implementation support practitioners, researchers, evaluators, funders, intermediaries…) want to limit the adaptations so that they know different sites (e.g., jurisdictions) are essentially implementing the same thing.
This is where thinking about forms and functions is helpful for effective adaptation planning and to better guide what adaptations might look like. It is a slightly different take than our old way of thinking about adaptations, where people distinguished between core components and peripheral components, which were hard to identify in the first place and sometimes less helpful than anticipated.
Planning for adaptations in a conscientious way
Despite the growing recognition that adaptations are often required, there's limited guidance on effective adaptation planning. Here are some concepts that we have found useful in thinking about adaptations.
First, it's important to distinguish a couple of components within the change initiatives that we are working on. Whenever we are trying to implement the "thing" (which might be a program, a practice, a guideline, or a policy), it has a couple of key components:
The WHO refers to all individuals asked to change.
The WHAT describes exactly what you want the WHOs to do, ideally based on evidence.
The HOW entails strategies to support these changes, ideally addressing underlying barriers and facilitators. We typically employ the StrategEase tool for this.
Unpacking forms and functions of the WHAT and the HOW.
Inspired by the work of implementation scientists, we now think about two components of the WHAT and two components of the HOW. These are functions and forms.
Functions describe the underlying purpose of a WHAT or HOW. The function of a WHAT is typically identified during program or practice design. For a HOW, the underlying function becomes evident when using tools like StrategEase tool to identify change strategies.
For instance, a WHAT or HOW's function could be communication (e.g., a poster or email), training (e.g., a workshop or professional development session), or persuasion (e.g., through a champion).
Forms describe how you deliver a WHAT or HOW that serves a specific function. While this might seem complex, consider the function of communication. It can take various forms like emails, in-person meetings, phone calls, or written materials in a waiting room, all serving the same communication function. Let's take another example. When the function is to train people, there can be various forms, such as in-person sessions, virtual workshops, or online courses, all fulfilling the training function.
Why forms and functions can help us in thinking about adaptations
Implementation support practitioners typically make adaptations to address the needs of the people they are serving, the people they are supporting to change, and to fit into the existing systems, structures, and processes. That often means that the initial form that a WHAT or HOW was in might not fit the context in which you are implementing. In this situation, we can think about how we can adapt the form of the WHAT or HOW without changing the underlying function that it is serving.
Consider an example where training is the function: In urban settings, in-person training might work well due to proximity. However, when rolling out the same initiative in remote rural areas, maintaining the training function while adapting the form is essential. This might involve virtual training, a train-the-trainer approach in smaller communities, or transitioning from one large session to multiple micro-training sessions. All of these are examples of adapting the form while maintaining the underlying function.
We believe there's still so much more to explore in unpacking how we think about forms and functions of the WHAT or HOW, which could help us be more strategic in making conscientious adaptations to meet people where they are at, find change initiatives that fit within the context, and serve people and communities. Figuring out how to use forms and functions is still a work in progress, but we see this as a great future direction to explore.
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