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Journal article
Fidelity matters: Implementing ADS Plus, an evidence-based program, in multiple adult day service sites
Innovation in aging, v 9(8), igaf074
Jul 2025
PMID: 40979469
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background and Objectives
In a cluster randomized trial, we found that augmenting adult day services (ADS) with a multicomponent caregiver support program, ADS Plus, reduced caregiver depressive symptoms and increased ADS use. Unclear is whether the program was implemented with fidelity across sites and the relationship of fidelity to site characteristics and caregiver outcomes.
Research Design and Methods
Sixteen ADS sites were randomly assigned to ADS Plus (n = 102 caregivers), which offered dementia education, referrals/linkages, validation/support, and strategies for self-care and caregiver-identified challenges. Sites were categorized with high, moderate, or low fidelity based on the number of caregivers enrolled (delivery), care challenges addressed, and prescriptions (strategies) provided (receipt). We examined staff documentation of delivery, receipt, and enactment characteristics, the relationship of fidelity to site characteristics, and caregiver outcomes (depressive symptoms, stress) collected by interviewers 3, 6, and 12 months postbaseline.
Results
Of 102 caregivers, 79.5% were in high (n = 58, 56.9%) or moderate (n = 23, 22.6%), versus 20.6% (n = 21) in low-fidelity sites. High/moderate versus low-fidelity sites delivered more sessions and spent less preparatory time. Caregiver receptivity to sessions was high across all sites. Caregivers with enactment data (n = 43) reported reduced difficulties and upset in high/moderate fidelity sites, and enhanced confidence managing care challenges in high-fidelity sites (p < .0001). Sites with higher percentages of White, non-Hispanic families (p = .006) and dementia clients (p = .004) had better fidelity. At three and 12 months but not at 6 months, caregivers in high/moderate fidelity sites had greater reductions in depressive symptoms and stress (p<.05) compared to those in low-fidelity sites.
Discussion and Implications
Most caregivers received ADS Plus with moderate to high fidelity. High/moderate fidelity sites delivered more sessions to more caregivers with substantially stronger caregiver benefits. As fidelity varied by site characteristics, adaptations to staff training and the program appear needed for low-fidelity sites.
Clinical Trial Registration Number NCT02927821</p>
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Details
- Title
- Fidelity matters: Implementing ADS Plus, an evidence-based program, in multiple adult day service sites
- Creators
- Laura N Gitlin (Corresponding Author) - Drexel UniversityKatherine B Marx - Johns Hopkins UniversityDavid L Roth - Johns Hopkins UniversityKeith Anderson - University of MississippiHolly Dabelko-Schoeny - The Ohio State UniversityDanny Scerpella - Johns Hopkins UniversityLauren J Parker - Johns Hopkins UniversitySokha KoeuthJoseph E Gaugler - University of Minnesota
- Publication Details
- Innovation in aging, v 9(8), igaf074
- Publisher
- Oxford University Press
- Number of pages
- 11
- Grant note
- National Institute on Aging of the National Institutes of Health: R01 AG049692 (Johns Hopkins University) This research was supported by the National Institute on Aging of the National Institutes of Health [R01 AG049692]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Nursing and Health Professions
- Web of Science ID
- WOS:001575838400001
- Scopus ID
- 2-s2.0-105016325365
- Other Identifier
- 991022061551604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Geriatrics & Gerontology
- Gerontology