Implementation
What you must know
Implementation is delivering the intervention as designed: recruiting and retaining participants, training staff and volunteers, producing and pretesting materials, coordinating logistics and partners, and monitoring delivery. It is where plans meet reality, so the exam emphasizes fidelity versus adaptation. Fidelity is delivering the core components exactly as designed; adaptation is tailoring to culture, context, or audience. Best practice preserves the core elements (the active ingredients) while adapting surface features such as language, examples, and setting. Document both.
Know pilot testing (small-scale trial to catch problems before full rollout), phasing (start small, then expand), and monitoring (tracking reach, dose delivered, dose received, and satisfaction) to drive real-time correction. This is formative work, not final judgment.
Know recruitment and retention strategies: trusted messengers, incentives, convenient times and locations, transportation and childcare, reminders, and stigma reduction. Attrition is the most common implementation failure; plan retention from day one.
Traps: labeling process monitoring as evaluation when the question asks about implementation activities; adapting away a core component and still claiming fidelity; skipping staff training and then blaming the curriculum; assuming a program proven elsewhere will transfer without cultural adaptation.
Rule of thumb: Adapt surface, protect the core, and write down what you changed and why.
Worked example: A diabetes self-management program is adopted for a Spanish-speaking parish. Facilitators translate materials and add a promotora co-leader (adaptation) but keep the seven core sessions, action-planning, and problem-solving steps intact (fidelity). Attendance is monitored weekly, and evening sessions are added when it drops.