Scaling-up Complex Interventions : Adaptation is not a Threat to Fidelity

Abstract

Practitioners delivering evidence-based interventions get pulled in different directions. It is intuitive to adapt interventions to context, but usually against ‘standard’ recommendations to do so. The nexus of the problem lies with different understandings of “complex.” This seminar puts forward the argument that with complex-system thinking, program scale-up should be less about precise replication and more about (re)generation according to the principal mechanisms of action. This means that fidelity and adaptation may co-exist, rather than the conventional logic, where adaptation is routinely seen as a threat to fidelity. With the complex way of thinking, intervention and context are intertwined. This means adaptation is not an add on consideration – it is integral to design and hence integral to transfer to every context. Practice has long been recognised as messy. Yet there remains a dominant orthodoxy which makes program implementation and scale-up sound simpler than it is. New ways forward will require innovative forms of quality assurance and accountability. This seminar investigates these issues, drawing on the burgeoning literature in complex systems and current examples from research with population-level interventions. It shows how insights from applied implementation practice could be harvested and harnessed to improve the reach and effect of interventions.