A modified theoretical framework to assess implementation fidelity of adaptive public health interventions

Background: One of the major debates in implementation research turns around fidelity and adaptation. Fidelity is the degree to which an intervention is implemented as intended by its developers. It is meant to ensure that the intervention maintains its intended effects. Adaptation is the process of implementers or users bringing changes to the original design of an intervention. Depending on the nature of the modifications brought, adaptation could either be potentially positive or could carry the risk of threatening the theoretical basis of the intervention, resulting in a negative effect on expected outcomes. Adaptive interventions are those for which adaptation is allowed or even encouraged. Classical fidelity dimensions and conceptual frameworks do not address the issue of how to adapt an intervention while still maintaining its effectiveness. Discussion: We support the idea that fidelity and adaptation co-exist and that adaptations can impact either positively or negatively on the intervention's effectiveness. For adaptive interventions, research should answer the question how an adequate fidelity-adaptation balance can be reached. One way to address this issue is by looking systematically at the aspects of an intervention that are being adapted. We conducted fidelity research on the implementation of an empowerment strategy for dengue prevention in Cuba. In view of the adaptive nature of the strategy, we anticipated that the classical fidelity dimensions would be of limited use for assessing adaptations. The typology we used in the assessment-implemented, not-implemented, modified, or added components of the strategy-also had limitations. It did not allow us to answer the question which of the modifications introduced in the strategy contributed to or distracted from outcomes. We confronted our empirical research with existing literature on fidelity, and as a result, considered that the framework for implementation fidelity proposed by Carroll et al. in 2007 could potentially meet our concerns. We propose modifications to the framework to assess both fidelity and adaptation. Summary: The modified Carroll et al.'s framework we propose may permit a comprehensive assessment of the implementation fidelity-adaptation balance required when implementing adaptive interventions, but more empirical research is needed to validate it

La globalización y el modelo de Medicina General Integral en Cuba: Retos y oportunidades

En este trabajo, tomando como base sus conocimientos y la literatura disponible, se expone una sinopsis de la esencia de la práctica médica contemporánea en el hemisferio occidental y la situación de la salud en el mundo actual. Se ven ambas situaciones como el resultado de los avances del proceso de globalización en estos últimos años. Al relacionarlas con la situación sanitaria de Cuba, surgen importantes respuestas e interrogantes frente al fundamental desarrollo diferenciado del sistema de salud cubano basado en la práctica de la Medicina General Integral en la atención primaria de salud. En esta situación de retos y también de oportunidades, nuestro modelo de desarrollo sanitario puede servir de paradigma a muchos países y a las personas que en todo el mundo están buscando nuevas orientaciones para hacer frente a los efectos de la globalización; por eso los autores se plantean seguir el necesario perfeccionamiento de las políticas, programas y acciones que logren, a través de la máxima cohesión de nuestras fuerzas, los más altos niveles posibles de desarrollo humano fundamentado en los valores de la equidad, sustentabilidad y democracia; tal como nos lo imponen nuestras aspiraciones sociales<br>In this paper, taking as a basis their knowledge and the literature available, the authors make a synopsis of the essence of contemporary practical medicine in the western hemisphere and of the present situation of medicine in the world. Both problems are seen as the result of the advances of the process of globalization in the last years. On comparing them with the health status in Cuba, important questions and answers appear in the face of the fundamental differentiated development of the Cuban health system based on the practice of Comprehensive General Medicine at the primary health care level. In this situation of challenges and opportunities, our model of health development may serve as a paradigm for many countries and persons that all over the world are looking for new options to face the effects of globalization. That´s why the authors recommend to go on with the necessary improvement of policies, programs and actions that attain, through the maximum cohesion of our forces, the highest possible levels of human development based on the values of equity, sustenance and democracy in accordance with our social aspiration

Mejorando la respuesta a la COVID-19: reorientación de los esfuerzos de comunicación de riesgos hacia cuestiones de equidad

Coronavirus disease 2019 (COVID-19) is, to date, the health problem with the highest impact in the 21st century. The World Health Organization has recommended several prevention and control measures to deal with this pandemic. In this context, social communication plays a key role. In this article we argue that the potential of communication efforts to close the gaps in the COVID-19 response worldwide won´t be fully accomplished until they do address equity-related issues.La enfermedad del coronavirus 2019 (COVID-19) es, hasta la fecha, el problema de salud de mayor impacto en el siglo XXI. La Organización Mundial de la Salud ha recomendado varias medidas de prevención y control para hacer frente a esta pandemia. En este contexto, la comunicación social juega un papel clave. En este artículo argumentamos que el potencial de los esfuerzos de comunicación para cerrar las brechas en la respuesta a la&nbsp; COVID-19 en todo el mundo no se logrará por completo hasta que no aborden los problemas relacionados con la equidad

Traslación a la práctica de estrategias de empoderamiento en la prevención del dengue : facilitadores y barreras

Objective. To identify facilitators and barriers to the process of translating community empowerment strategies into the practice of the national Aedes aegypti control program in Cuba. Methods. A case study of the process was conducted from 2005 to 2009 at national and provincial levels of the control program. Data from participant observation, in-depth interviews, and document analysis were triangulated and analyzed inductively and deductively. Results. The main facilitators identified included a proposal for an empowerment strategy effective in reducing Aedes aegypti infestation, which was explained in such a way that it could be implemented by program staff; and a control program with national coverage capable of implementing the proposal. The principal barriers were the complexity of the strategy and the absence of organizational changes needed to facilitate its insertion into the control program. Each barrier or facilitator identified was either static or dynamic in nature. Dynamic factors are those that offer signals for action. Conclusions. Multiple barriers and facilitators influence the process of translating community empowerment strategies into the practice of the Cuban Aedes aegypti control program. The analysis of these factors as either static or dynamic makes it possible to design more appropriate and effective strategies that can promote the process and increase the likelihood of success