Impact of time restraints on program fidelity in a counseling and testing HIV intervention

Introduction: Evidence-based health programs require sufficient timeframes for implementation to maintain fidelity to the program's core elements. Pre-implementation assessments of program fit should include consideration of time factors, but little is known about whether this takes place and the impact of time constraints on fidelity. The present study examines the impact of time factors on fidelity to RESPECT, a counseling-and-testing HIV intervention. Methods: Program delivery (PD) staff (N=70) from a national sample of 30 urban/non-urban departments of public health and community-based organizations delivering RESPECT participated in semi-structured interviews. Using NVivo8, qualitative content analyses of PD interviews were conducted to examine organizational and programmatic time factors that influenced program delivery. Results: Three themes emerged from the interviews: (1) insufficient time was a barrier to program fidelity for most agencies, (2) organizational (e.g., staffing, policies, workload) and environmental (e.g., group, field settings) factors increased or reduced the time-related impacts on fidelity, and (3) the adaptations to time restraints that reduced fidelity included abandoning the program and modifying or eliminating key elements. A few agencies described utilizing successful strategies for managing time-related barriers and improving fidelity. Conclusions: Insufficient time appears to be a critical antecedent driving adaptations that reduce fidelity. Agency capacity to provide adequate time for program activities should be considered during pre-implementation assessment, as failure to consider program fit within the time constraints, workload, and client flow of an agency can reduce fidelity. Adequate timeframes should be considered key elements by program developers when designing protocols for dissemination and evaluation.