Do Program Implementation Factors or Fidelity Affect Chronic Disease Self-Management Education Programs’ Outcomes?

Purpose: To evaluate whether implementation factors or fidelity moderate chronic disease self-management education program outcomes. Design: Meta-analysis of 34 Arthritis Self-Management Program and Chronic Disease Self-Management Program studies. Setting: Community. Participants: N = 10 792. Measures: Twelve implementation factors: program delivery fidelity and setting and leader and participant characteristics. Eighteen program outcomes: self-reported health behaviors, physical health status, psychological health status, and health-care utilization. Analysis: Meta-analysis using pooled effect sizes. Results: Modest to moderate statistically significant differences for 4 of 6 implementation factors; these findings were counterintuitive with better outcomes when leaders and participants were unpaid, leaders had less than minimum training, and implementation did not meet fidelity requirements. Conclusion: Exploratory study findings suggest that these interventions tolerate some variability in implementation factors. Further work is needed to identify key elements where fidelity is essential for intervention effectiveness.