Fiscal loss and program fidelity: impact of the economic downturn on HIV/STI prevention program fidelity

• Published in: Translational behavioral medicine 2014-03, Vol.4 (1), p.34-45
• Main Authors: Catania, Joseph A, Dolcini, M Margaret, Gandelman, Alice A, Narayanan, Vasudha, Mckay, Virginia R
• Format: Article
• Language: English
• Subjects: Cross Cultural Psychology; Family Medicine; General Practice; Health Promotion and Disease Prevention; Health Psychology; Medicine; Medicine & Public Health; Original Research; Public Health
• ISSN: 1869-6716; 1613-9860
• DOI: 10.1007/s13142-013-0242-z

ABSTRACT The economic downturn of 2007 created significant fiscal losses for public and private agencies conducting behavioral prevention. Such macro-economic changes may influence program implementation and sustainability. We examined how public and private agencies conducting RESPECT, a brief HIV/STI (sexually transmitted infection) counseling and testing intervention, adapted to fiscal loss and how these adaptations impacted program fidelity. We collected qualitative and quantitative data in a national sample of 15 agencies experiencing fiscal loss. Using qualitative analyses, we examined how program fidelity varied with different types of adaptations. Agencies reported three levels of adaptation: agency-level, program-level, and direct fiscal remedies. Private agencies tended to use direct fiscal remedies, which were associated with higher fidelity. Some agency-level adaptations contributed to reductions in procedural fit, leading to negative staff morale and decreased confidence in program effectiveness, which in turn, contributed to poor fidelity. Findings describe a “work stress pathway” that links program fiscal losses to poor staff morale and low program fidelity.