Fidelity monitoring

What is in this resource and who is it for?

This resource explains the key elements of program fidelity and monitoring. It covers why it is important for program or service delivery as well as how practices can be implemented, maintained and adjusted.

Each section outlines important aspects of developing or maintaining fidelity as well as key considerations in the process to help ensure your intended program outcomes can be achieved.

In this resource, we refer to packaged or manualised programs. These are evidence-based interventions that come with a structured set of materials and guidelines - often in the form of a manual - to ensure consistent delivery.

This resource is intended to support practitioners and program managers who are working in child and family support services to deliver established programs or develop new programs. Practitioners who deliver packaged or manualised programs, or who are looking to scale up a locally developed program, may find this resource especially helpful.

What is program fidelity and why is it important?

The term 'program fidelity' refers to how closely the delivery of a program follows its original design and the developer's intentions.

Maintaining fidelity is important because deviating from core program content, or how it is delivered, may limit the effectiveness of the program. This is particularly important if you are delivering a packaged or manualised program that requires adherence to the core program activities to be effective. This is because while many programs may be evidence-based, if they are not delivered as designed, they may not work as intended.

Fidelity to program design is also important for scaling up a program or delivering a program in new sites or contexts.

For example, a child and family service has designed a new program that aims to support child development by role modelling parenting skills and developmentally appropriate play, and they have implemented the program in a particular location. The service would now like to expand the program to a range of new locations. However, the success of the program relies on facilitators to deliver all components of the program as intended. If any of the facilitators modify any of the core components, or deliver it in different ways at different locations, it will be hard to know what has caused any good or bad outcomes observed in the program. This then makes it hard to scale up the program because the findings of any evaluation, research or measurement cannot be easily generalised to other communities or populations (Allen et al., 2018).

Key features of program fidelity

To assess program fidelity, we need to understand which parts of the program are core components and which are flexible components that can be modified.

Core components are generally the main parts or features of a program, including:

• program content and the order in which that content is delivered
• program dosage or exposure (e.g. the required number of sessions or the frequency or length of sessions)
• quality of delivery (e.g. the extent to which delivery of the program draws on the best available evidence for good practice and is delivered by a facilitator with appropriate resources, skills and experience). This might relate to the service delivery setting, the mode of delivery, the style of facilitation or the training the facilitator has received.

Core components are often evidence-based. They are the elements of the program's content or delivery that have either been:

• developed based on an established body of research evidence, and/or
• subjected to rigorous evaluation and monitoring to demonstrate they are likely to lead to the intended outcomes.

Any adaptations to these components would generally result in a significant change to the program and may reduce the quality of the program and compromise the program outcomes.¹

By contrast, flexible components are elements of a program that can be changed without having a significant impact on the program's design. Examples of flexible components include the language of the program or promotional materials, or the examples or case studies provided as part of program delivery that can be adapted to accommodate the cultural needs or experiences of participants.

These are discussed further below, along with other examples of flexible components.

Identifying the core components of a program

It can sometimes be difficult to identify which program components are core components. If you are delivering a packaged or manualised program, your program manual may indicate which components should not be changed without consultation with the program developers.

However, if you are delivering a locally developed program or are working on an intervention without a comprehensive manual, identifying the core components can be more challenging. It can help to start by developing a clear understanding of how the program works and how it is supposed to create change for the issue you are trying to address. You may have identified these core components through program monitoring or evaluation.

Identifying the flexible components of a program

Not all programs can be delivered in the same way to all types of clients or in all types of communities or service delivery settings. There are times when you may need to adjust some elements of your program to make them suitable or practical for your local context (Allen et al., 2018).

This may particularly be the case when you are delivering an older, established program or a packaged or manualised program that was developed in a context or for use with a specific population that differs from your service delivery context.

It can sometimes be difficult to identify when you need to adapt a program. A needs assessment process might help you to better understand the needs of your community or target population - which might give you some clues as to whether parts of a program need to be adapted in response to those needs. This may be because:

• Your setting differs from that of the original program (e.g. you are implementing a program in a culturally different setting than that of the original program and the materials need to be made more culturally relevant).
• Your program clients or consumers are different (e.g. you are implementing the program with participants who have different characteristics to those with whom the original program was developed or tested).
• You need to adjust the language or communication style of program materials (e.g. translating materials to other languages, modifying vocabulary to increase understanding or catering to different learning abilities or literacy levels).
• You need to modify activities to increase engagement while keeping the content consistent (e.g. you need to tailor promotional materials or case study examples to the experiences of participants).

Making adaptations

Before adapting a program, it is important to consider any changes carefully so that you maintain the underlying evidence base for the intervention and do not inadvertently reduce the effectiveness.

If you decide you need to make adaptations to a manualised program or as part of a plan to scale up a local program, there are some critical points to consider. Note, these may vary from program to program and you should take your context into account.

• Start by having a clear definition and understanding of the core components of your program and use that to identify what the acceptable adaptations would be. This may require you to invest time and resources in needs assessment or evaluation activities before you can identify what parts of the program may be flexible. Ideally, you would document this thinking as part of your program planning and implementation processes, and as part of any needs assessment or evaluation reports.
• If you are delivering a program that you have purchased or licenced from another program developer, including a manualised program, you should consult with that developer before you implement any adaptations. They may be able to identify the core and flexible components and suggest what adaptations are appropriate.
• It can be helpful to establish a process or select a person responsible for assessing any necessary adaptations. This may be a management team or reference group or a technical advisor (such as the program developer).
• You may decide to develop and apply an adaptation framework. This could be a formal process using an existing tool or process map (The Center for Implementation, 2025) or it may be a less formal process of documenting how, when and why adaptations to a program may be made (Allen et al., 2018; Kershner et al., 2014; Perez et al., 2011).

Maximising fidelity

While there are times when you might need to make a deliberate adaptation to a program, it is also common for established programs to experience some 'drift'; that is, where adherence to the original program design diminishes over time and unplanned changes are introduced. Issues with maintaining fidelity often arise where program monitoring practices are relaxed or removed, or where they were never implemented in the first place (Nelson et al., 2015).

You can minimise the risk of program drift by taking steps to maximise fidelity in program implementation, including:

• developing an implementation plan that is linked to routine program monitoring, and building in processes that allow key people to regularly reflect on what that monitoring data is telling you about the program
• ensuring that the practitioners implementing your program have the resources, skills and knowledge required to deliver the program as intended.
• providing regular refresher training for program implementers
• referring to (or developing) a program manual, set of program materials or tip sheets to help maintain consistent delivery of the program (Allen et al., 2018).

You can read more about monitoring fidelity in the section below.

Monitoring program fidelity

Why does fidelity need to be monitored?

Monitoring for program fidelity ensures that unintentional deviations from how the program should be delivered are kept to a minimum.

This monitoring allows practitioners to identify and understand challenges with program implementation as they arise and make improvements and adjustments to strengthen the program. For example, the data collected through program monitoring can help to identify any additional training or resource needs facilitators may have.

How to monitor fidelity

How you monitor fidelity will depend on the availability of resources you have and what key features of fidelity you decide to monitor. Process evaluation looks at how a program is being delivered to see if it is working as planned. It is often an effective way to monitor fidelity and identify whether the program needs to be adapted, or to address any unintended or unplanned changes to the way in which a program is delivered.

If a process evaluation isn't feasible in your context, there are a variety of other methods you could consider drawing on as part of a continuous improvement or learning approach. Common ways to collect data about program fidelity include:

• Direct observation of program sessions: This involves either a third party or project supervisor observing the facilitators as they implement the program sessions. This method allows for real-time feedback on adherence, quality of delivery and participant responsiveness but is the most resource intensive style of monitoring (Sanetti et al., 2021).
• Video or audio recording program delivery: Video or audio recording allows for post-hoc feedback for the person monitoring the implementation of the program. Where programs are short on resources, having the option for facilitators to review recordings can also be helpful (Nelson et al., 2015; Tiwari et al., 2021).
• Administrative or program data: Program or service staff can review administrative data and/or records such as session dates and times, participant attendance, participant characteristics and program content guides to assess factors such as adherence to intended program dosage, program content and participant engagement.

The following table sets out some further examples of how you can monitor the core components that are key to program fidelity (Feely et al., 2018).

Table 1: Examples of approaches to monitoring fidelityHow often you monitor fidelity will depend on your program context and how regularly it is delivered. If the program is newly implemented or recently scaled up, you might consider more regular monitoring activities. Once you are satisfied that your program is being delivered with good fidelity, you may be able to undertake less frequent (but still regular) monitoring activities.

Whatever frequency you decide, it is a good idea to document your monitoring plans and any findings or actions that arise from that monitoring.

Measuring fidelity

If you deliver a packaged or manualised program, the program's developer might set the acceptable standard of fidelity; that is, the extent to which there is flexibility to adapt elements of the program to the local context and how you can measure whether you are implementing the program correctly. This information is likely to be found in the program manual, or you could contact the program developer for advice.

If the developer has not provided guidance about the acceptable standard of fidelity, or you are looking at scaling up a locally developed program, then you may need to identify a suitable tool or design a tool to measure fidelity. Depending on the method of monitoring you choose, your measurement tool may be an observational checklist or a survey to use with program facilitators or clients.

Each of these can be challenging to develop on your own and it may be helpful to seek assistance from someone in your organisation with experience or from an external organisation. You can find out more about selecting or developing observational tools and surveys from the resources in the Further reading section below.

When developing a fidelity monitoring plan, it is important to document and consider:

• how any monitoring plan will be implemented within your program or organisation, and who is responsible for the plan
• whether there is a need to allocate or specify funding or resources to support fidelity monitoring
• your process for correcting any program or delivery 'drift'
• when (and how often) you will review your monitoring plans.

Depending on the skills and resources you have available within your organisation, you might consider whether this is something you can maintain in-house or whether you should work with an external partner to undertake some or all of the monitoring work. You can also refer to the Further reading section below for more guidance.

Creating feedback loops

Feedback loops are an important part of any process to monitor and maximise program fidelity because feedback is essential for quickly identifying and resolving problems. When collecting monitoring data about your program, it is not enough to just gather the information - you also need to establish processes to reflect on what the data are telling you about the program and to act based on what you learn. Depending on your program, it can be helpful to involve facilitators, leaders, decision makers and/or participants in this feedback process.

Feedback loops can look different across different organisations but some common elements might include:

• regular check-ins with key program stakeholders (e.g. program facilitators, managers, trainers or participants) to identify challenges or issues with program delivery or implementation. This might include identifying individuals who may require additional training, addressing issues related to staff turnover that could affect program delivery and fidelity, or collecting feedback from program facilitators regarding the program's suitability for participant needs. For some programs, periodic check-ins with the program developers can also be useful for discussing any arising issues or questions about program content or delivery.
• opportunities for program staff to self-assess. This may include offering regular opportunities for participants to provide feedback or developing a routine practice of facilitators reflecting on the extent to which their practice aligns with the program manual (Walsh et al., 2015).

Conclusion

Fidelity monitoring plans and embedded feedback loops are essential for maintaining program fidelity in the long term. This does not mean that programs cannot evolve or adapt over time in response to emerging evidence or changing participant needs; rather, maintaining program fidelity is about ensuring that any adaptations to the program are made in a considered way and with reference to evidence about 'what works' in any given context.

Further reading

Needs assessment | Australian Institute of Family Studies
This resource is for practitioners and policy makers who want to learn more about the needs assessment process or how to conduct a needs assessment.

Implementation in action | Australian Institute of Family Studies
The purpose of this guide is to help in the implementation of evidence-informed programs and practices in the child and family service sector.

Process evaluation | Australian Institute of Family Studies
An introductory guide to process evaluation, explaining how to assess program implementation, understand fidelity and improve service quality in family and community programs.

How to write a survey questionnaire for evaluation: A guide for beginners | Australian Institute of Family Studies
The resource provides basic information and practical tips to help you design and implement simple survey questionnaires for your program evaluation activities

Observation: a guide for use in evaluation
This resource explains how observation can be used as a systematic and flexible method for collecting qualitative and quantitative data to support evidence‑based evaluation. [education.nsw.gov.au]

Collect and/ or retrieve data - Rainbow Framework
This section of the Rainbow Framework outlines how to collect or retrieve data to describe activities, outcomes and context, helping answer key evaluation questions about what has happened.

Planning an evaluation | Australian Institute of Family Studies
This resource is for evaluation beginners needing help with developing an evaluation plan for a program, project or service for children and families.

Making Adaptations to Evidence-Based Programs Tip Sheet
This tip sheet explains how to adapt evidence‑based programs to better suit specific populations or settings without undermining core components.

Bibliography

Allen, J., Shelton, R., Emmons, K., & Linnan, L. (2018). Fidelity and its relationship to implementation effectiveness, adaptation and dissemination. In R. C. Brownson, G. A. Colditz, & E. K. Proctor (Eds.), Dissemination and implementation research in health: Translating science to practice (2nd ed., pp. 267-284). Oxford University Press.

Bonde, A. H., Stjernqvist, N. W., Sabinsky, M. S., & Maindal, H. T. (2018). Process evaluation of implementation fidelity in a Danish health-promoting school intervention. BMC Public Health, 18(1), 1407. doi.org/10.1186/s12889-018-6289-5

Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2, 40. doi.org/10.1186/1748-5908-2-40

Feely, M., Seay, K. D., Lanier, P., Auslander, W., & Kohl, P. L. (2018). Measuring fidelity in research studies: A field guide to developing a comprehensive fidelity measurement system. Child and Adolescent Social Work Journal, 35(2), 139-152. doi.org/10.1007/s10560-017-0512-6

Kershner, S., Flynn, S., Prince, M., Potter, S. C., Craft, L., & Alton, F. (2014). Using data to improve fidelity when implementing evidence-based programs. Journal of Adolescent Health, 54(3), S29-S36. doi.org/10.1016/j.jadohealth.2013.11.027

Lemire, C., Rousseau, M., & Dionne, C. (2023). A Comparison of fidelity implementation frameworks used in the field of early intervention. American Journal of Evaluation, 44(2), 236-252. doi.org/10.1177/10982140211008978

Martin, M., Lachman, J. M., Murphy, H., Gardner, F., & Foran, H. (2023). The development, reliability, and validity of the Facilitator Assessment Tool: An implementation fidelity measure used in Parenting for Lifelong Health for Young Children. Child: Care, Health and Development, 49(3), 591-604. doi.org/10.1111/cch.13075

Martin, M., Steele, B., Lachman, J. M., & Gardner, F. (2021). Measures of facilitator competent adherence used in parenting programs and their psychometric properties: A systematic review. Clinical Child and Family Psychology Review, 24(4), 834-853. doi.org/10.1007/s10567-021-00350-8

Nelson, J. R., Oliver, R. M., Hebert, M. A., & Bohaty, J. (2015). Use of self-monitoring to maintain program fidelity of multi-tiered interventions. Remedial and Special Education, 36(1), 14-19. doi.org/10.1177/0741932514544970

NSW Government. (2024, February 20). What contributes to a successful program? Small Group Tuition. education.nsw.gov.au/teaching-and-learning/curriculum/small-group-tuition/about/what-contributes-to-a-successful-program

Perez, D., Lefevre, P., Castro, M., Sanchez, L., Toledo, M. E., Vanlerberghe, V. et al. (2011). Process-oriented fidelity research assists in evaluation, adjustment and scaling-up of community-based interventions. Health Policy and Planning, 26(5), 413-422. 
doi.org/10.1093/heapol/czq077

Sanetti, L. M. H., Cook, B. G., & Cook, L. (2021). Treatment fidelity: What it is and why it matters. Learning Disabilities Research & Practice, 36(1), 5-11. doi.org/10.1111/ldrp.12238

The Centre for Implementation. (2025). Map2Adapt Tool [Web application]. thecenterforimplementation.com/map2adapt-tool

Tiwari, A., Whitaker, D., & Self-Brown, S. (2021). Comparing fidelity monitoring methods in an evidence-based parenting intervention. Journal of Children's Services, 16(2), 104-116. doi.org/10.1108/JCS-01-2020-0005

Walsh, C., Rolls Reutz, J., & Williams, R. (2015). Selecting and implementing evidence-based practices: A Guide for child and family serving systems. California Evidence-Based Clearinghouse for Child Welfare. www.cebc4cw.org/files/CEBC_Imp_Guide_2016_Colors.pdf

1 While some research has been conducted to identify the evidence-based components of programs for children and families, or the common elements of programs with some evidence of effectiveness, this research is still emerging. Where there is uncertainty, services should be cautious about changing program components without having adequate program monitoring processes in place.