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.