Assessing Implementation Fidelity in a Community Health Improvement Plan

This paper describes and analyzes a pre-post non-experimental process evaluation in a Community Health Improvement Plan and the building of evidence for program improvement in the Plan, Do, Check and Act (PDCA) continuous improvement cycle with a focus on the Check and Act steps. The findings will help stakeholders to gain insight into plan implementation and consider necessary design and process adjustments. An overall mean completion rate of 60.44% was recorded with achievement scores ranging from 0% (goals 4 and 5) to 87.92% (goal 1). At the mid-point of implementation, completion for each priority issue was as follows: completion and fidelity rates for action steps addressing healthy behaviors priority issue was 78.05%, the implementation rate for action steps addressing Health Care Capacity, Access, and Delivery priority issue was 43.38%; and the completion rate for action steps addressing changes in policy systems, environment priority issue was at 50%. The level of implementation completion for each priority issue and corresponding action steps aligns with the degree of issue complexity predicted in the conceptual framework. These patterns suggest that initiatives that addressed fundamental causes of poor health status are harder to implement as evidenced by lower completion and fidelity rates.