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

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Translational Behavioral Medicine

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.

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Acknowledgments

We would like to thank Lance Pollack, Ph.D. (University of California San Francisco), Kim Richards, Ph.D., Kathleen Conte, MA, Marcia Macomber, MS (Oregon State University) and Westat Corporation for assistance in data collection, extraction and analytical work, and Carla Cudmore and Natalie Tiexiera for help in manuscript preparation. This research was supported by a grant from NIMH MH085502 to Dr. Dolcini.

Author information

Authors and Affiliations

  1. Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, 2631 SW Campus Way, Corvallis, OR, 97330, USA

    Joseph A Catania PhD, M Margaret Dolcini PhD & Virginia R Mckay MS

  2. California STD/HIV Prevention Training Center, University of California, San Francisco, CA, USA

    Alice A Gandelman MPH

  3. Westat Corporation, Rockville, MD, USA

    Vasudha Narayanan MA, MBA, MS

Authors
  1. Joseph A Catania PhD
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  2. M Margaret Dolcini PhD
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  3. Alice A Gandelman MPH
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  4. Vasudha Narayanan MA, MBA, MS
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  5. Virginia R Mckay MS
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Corresponding author

Correspondence to Joseph A Catania PhD.

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Implications

Practice: Agencies experiencing fiscal loss should consider the impact of adaptations on staff morale and program fidelity, and when possible, make choices that enhance implementation.

Policy: Economic factors have had a negative impact on implementation of behavioral HIV prevention programs, placing strain on the public health safety net.

Research: Implementation is influenced by economic factors and further research is needed to identify best practices for sustaining evidence-based programs in the face of fiscal loss.

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Catania, J.A., Dolcini, M.M., Gandelman, A.A. et al. Fiscal loss and program fidelity: impact of the economic downturn on HIV/STI prevention program fidelity. Behav. Med. Pract. Policy Res. 4, 34–45 (2014). https://doi.org/10.1007/s13142-013-0242-z

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  • DOI: https://doi.org/10.1007/s13142-013-0242-z

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