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

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.

DOI: 10.1007/s13142-013-0242-z

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Cite this paper

@article{Catania2014FiscalLA, title={Fiscal loss and program fidelity: impact of the economic downturn on HIV/STI prevention program fidelity.}, author={Joseph A. Catania and Margaret M. Dolcini and Alice A Gandelman and Vasudha Narayanan and Virginia R. McKay}, journal={Translational behavioral medicine}, year={2014}, volume={4 1}, pages={34-45} }