实施性研究中实施保真度的研究进展及启示

doi:10.3761/j.issn.0254-1769.2026.12.018

中华护理杂志 ›› 2026, Vol. 61 ›› Issue (12): 1717-1723.DOI: 10.3761/j.issn.0254-1769.2026.12.018

实施性研究中实施保真度的研究进展及启示

张小艳¹(), 李学靖², 郝玉芳²^,^*()

¹ 北京医院（国家老年医学中心）血管外科，老年疾病国家临床医学研究中心，国家卫生健康委老年医学重点实验室，中国医学科学院老年医学研究院北京市 100730
² 北京中医药大学护理学院北京市 102448

收稿日期:2025-10-29 出版日期:2026-06-20 发布日期:2026-06-12
*通讯作者: 郝玉芳，E-mail：bucmnursing@163.com
作者简介:张小艳：女，博士，主管护师，E-mail：Jane_haha@163.com
第一联系人：作者贡献声明
张小艳：文献检索、论文撰写、经费支持；李学靖：文献检索与整理；郝玉芳：研究指导、论文修改
基金资助:
中央高校基本科研业务费专项资金(3332024098)

Research progress and implications of implementation fidelity in implementation research

ZHANG Xiaoyan¹(), LI Xuejing², HAO Yufang²^,^*()

¹ Department of Vascular Surgery， Beijing Hospital，National Center for Gerontology，National Clinical Research Center for Gerontology，the Key Laboratory of Geriatrics of NHC，Institute of Geriatric Medicine，Chinese Academy of Medical Sciences， Beijing 100730， China
² School of Nursing， Beijing University of Chinese Medicine， Beijing 102448， China

Received:2025-10-29 Online:2026-06-20 Published:2026-06-12
* Corresponding author: HAO Yufang，E-mail：bucmnursing@163.com
Funding program:
Fundamental Research Funds for the Central Universities(3332024098)

摘要/Abstract

摘要：

实施保真度是实施性研究的核心过程指标。该研究探讨了实施性研究中实施保真度的基本概念、核心要素、评估方法、常用保障策略，并建议未来研究者关注实施保真度的标准化评估、平衡高保真度与高适应性的阈值、完善与验证相关理论、构建实施保真度的报告规范、探索实施保真度与实施结果的因果关系等，以期为国内护理领域相关研究的开展提供参考。

关键词: 实施性研究, 实施保真度, 实施策略, 证据转化, 综述, 护理

Abstract:

Implementation fidelity is a core process indicator in implementation research. This study has explored the concept，key elements，measurement tools and methodologies，as well as commonly utilized control strategies of implementation fidelity within the realm of implementation research. Additionally，it is suggested that future researchers should pay attention to research directions such as the standardization of assessment and measurement for implementation fidelity，the threshold balance between high fidelity and high adaptability，the refinement and validation of relevant theories，the reporting guidelines for implementation fidelity，and the investigation of the causal relationship between implementation fidelity and implementation outcomes. These efforts aim to provide valuable references for relevant research in the domestic nursing field.

Key words: Implementation Research, Implementation Fidelity, Implementation Strategies, Evidence Translation, Review, Nursing Care

张小艳, 李学靖, 郝玉芳. 实施性研究中实施保真度的研究进展及启示[J]. 中华护理杂志, 2026, 61(12): 1717-1723.

ZHANG Xiaoyan, LI Xuejing, HAO Yufang. Research progress and implications of implementation fidelity in implementation research[J]. Chinese Journal of Nursing, 2026, 61(12): 1717-1723.

参考文献 43

[1]	Proctor EK, Powell BJ, McMillen JC. Implementation strategies:recommendations for specifying and reporting[J]. Implement Sci, 2013, 8:139. DOI PMID
[2]	熊伟剑, 赵婷, 文颀, 等. 急诊群体伤患者信息化护理管理方案的构建及初步应用[J]. 中华护理杂志, 2025, 60(24):2979-2985. DOI
	Xiong WJ, Zhao T, Wen Q, et al. Construction and preliminary application of an information-based nursing management proto-col for mass casualty patients in the emergency care[J]. Chin J Nurs, 2025, 60(24):2979-2985.
[3]	杨童玲, 陈玉莹, 万凡, 等. 新生儿居家皮肤护理指导方案的构建及初步应用研究[J]. 中华护理杂志, 2025, 60(6):680-687. DOI
	Yang TL, Chen YY, Wan F, et al. Development and initial im-plementation of a neonatal home skin care guidance scheme[J]. Chin J Nurs, 2025, 60(6):680-687.
[4]	Carroll C, Patterson M, Wood S, et al. A conceptual framework for implementation fidelity[J]. Implement Sci, 2007, 2:40. PMID
[5]	Durlak JA, DuPre EP. Implementation matters:a review of re-search on the influence of implementation on program out-comes and the factors affecting implementation[J]. Am J Com-munity Psychol, 2008, 41(3/4):327-350.
[6]	An M, Dusing SC, Harbourne RT, et al. What really works in intervention? Using fidelity measures to support optimal out-comes[J]. Phys Ther, 2020, 100(5):757-765. DOI URL
[7]	Klabbers RE, Feldacker C, Huwa J, et al. Looking under the hood of a hybrid two-way texting intervention to improve early retention on antiretroviral therapy in Malawi:an implementa-tion fidelity evaluation[J]. Implement Sci, 2025, 20(1):6. DOI PMID
[8]	Eiraldi R, Lawson GM, Glick HA, et al. Implementation fidelity,student outcomes,and cost-effectiveness of train-the-trainer stra-tegies for Masters-level therapists in urban schools:results from a cluster randomized trial[J]. Implement Sci, 2024, 19(1):4. DOI
[9]	Choi H, Jung YI, Kim H. Implementation fidelity of the Sys-tems for Person-Centered Elder Care(SPEC):a process evalua-tion study[J]. Implement Sci, 2021, 16(1):52. DOI
[10]	Hoekstra F, van Offenbeek MAG, Dekker R, et al. Implementa-tion fidelity trajectories of a health promotion program in mul-tidisciplinary settings:managing tensions in rehabilitation care[J]. Implement Sci, 2017, 12(1):143. DOI PMID
[11]	单亚维, 郝玉芳. 证据转化与应用中实施性研究的结局评价[J]. 中国护理管理, 2024, 24(12):1766-1770.
	Shan YW, Hao YF. Outcomes evaluation of implementation research for evidence translation and implementation[J]. Chin Nurs Manag, 2024, 24(12):1766-1770.
[12]	Toomey E, Hardeman W, Hankonen N, et al. Focusing on fide-lity:narrative review and recommendations for improving intervention fidelity within trials of health behaviour change interventions[J]. Health Psychol Behav Med, 2020, 8(1):132-151. DOI PMID
[13]	Moncher FJ, Prinz RJ. Treatment fidelity in outcome studies[J]. Clin Psychol Rev, 1991, 11(3):247-266. DOI URL
[14]	Steckler A, Linnan L, et al. Process evaluation for public health interventions and research[M]. San Francisco,Calif.: Jossey-Bass, 2002.
[15]	Bellg AJ, Borrelli B, Resnick B, et al. Enhancing treatment fide-lity in health behavior change studies:best practices and recommendations from the NIH Behavior Change Consortium[J]. Health Psychol, 2004, 23(5):443-451.
[16]	Fixsen DL, Naoom SF, Blase KA, et al. Implementation research:a synthesis of the literature[M]. Tampa,Florida: Louis de la Parte Florida Mental Health Institute Publication, 2005.
[17]	O’Donnell CL. Defining,conceptualizing,and measuring fidelity of implementation and its relationship to outcomes in K-12 curriculum intervention research[J]. Rev Educ Res, 2008, 78(1):33-84. DOI URL
[18]	Proctor E, Silmere H, Raghavan R, et al. Outcomes for imple-mentation research:conceptual distinctions,measurement chal-lenges,and research agenda[J]. Adm Policy Ment Health, 2011, 38(2):65-76. DOI PMID
[19]	Gearing RE, El-Bassel N, Ghesquiere A, et al. Major ingre-dients of fidelity:a review and scientific guide to improving quality of intervention research implementation[J]. Clin Psy-chol Rev, 2011, 31(1):79-88.
[20]	Walton H, Spector A, Williamson M, et al. Developing quality fidelity and engagement measures for complex health inter-ventions[J]. Br J Health Psychol, 2020, 25(1):39-60. DOI PMID
[21]	Powell SR, Berry KA, Acunto AN, et al. Applying an indivi-dual word-problem intervention to a small-group setting:a pilot study’s evidence of improved word-problem performance for students experiencing mathematics difficulty[J]. J Learn Disabil, 2022, 55(5):359-374. DOI URL
[22]	Cross W, West J, Wyman PA, et al. Observational measures of implementer fidelity for a school-based preventive interven-tion:development,reliability,and validity[J]. Prev Sci, 2015, 16(1):122-132. DOI URL
[23]	Powers K, Clarke S, Phillips J, et al. Developing an implemen-tation fidelity checklist for a vocational rehabilitation inter-vention[J]. Pilot Feasibility Stud, 2022, 8(1):234. DOI PMID
[24]	Cross WF, McCarten J, Funderburk JS, et al. Measuring fidelity of brief cognitive behavior therapy for insomnia:develop-ment,reliability and validity[J]. Eval Program Plann, 2025, 109:102531. DOI URL
[25]	Borrelli B. The assessment,monitoring,and enhancement of treat-ment fidelity in public health clinical trials[J]. J Public Health Dent, 2011, 71(Suppl 1):S52-S63.
[26]	Ginsburg L, Hoben M, Berta W, et al. Development and vali-dation of the Overall Fidelity Enactment Scale for Complex Interventions(OFES-CI)[J]. BMJ Qual Saf, 2024, 33(2):98-108. DOI URL
[27]	Ginsburg LR, Hoben M, Easterbrook A, et al. Examining fide-lity in the INFORM trial:a complex team-based behavioral intervention[J]. Implement Sci, 2020, 15(1):78. DOI PMID
[28]	Craig P, Dieppe P, MacIntyre S, et al. Developing and evalua-ting complex interventions:the new Medical Research Council guidance[J]. Int J Nurs Stud, 2013, 50(5):587-592. DOI URL
[29]	Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions:Template for Intervention Description and Repli-cation(TIDieR) checklist and guide[J]. Bmj, 2014, 348(mar07 3):g1687. DOI URL
[30]	Rhon DI, Fritz JM, Kerns RD, et al. TIDieR-telehealth:precision in reporting of telehealth interventions used in clinical trials-unique considerations for the Template for the Inter-vention Description and Replication(TIDieR) checklist[J]. BMC Med Res Methodol, 2022, 22(1):161. DOI
[31]	Dolcini MM, Davey-Rothwell MA, Singh RR, et al. Use of effe-ctive training and quality assurance strategies is associated with high-fidelity EBI implementation in practice settings:a case analysis[J]. Transl Behav Med, 2021, 11(1):34-45. DOI URL
[32]	施兰君, 岗卫娟, 田紫煜, 等. 保真度及其在针灸临床研究中的应用与思考[J]. 中国针灸, 2023, 43(7):813-817.
	Shi LJ, Gang WJ, Tian ZY, et al. Fidelity in acupuncture-moxibustion clinical research:application and reflection[J]. Chin Acupunct Moxibustion, 2023, 43(7):813-817.
[33]	Dean SG, Poltawski L, Forster A, et al. Community-based reha-bilitation training after stroke:results of a pilot randomised controlled trial(ReTrain) investigating acceptability and feasi-bility[J]. BMJ Open, 2018, 8(2):e018409. DOI URL
[34]	Moore G, Campbell M, Copeland L, et al. Adaptation of inter-ventions for implementation and/or re-evaluation in new con-texts:the ADAPT study guidance(v1.0)[EB/OL].(2020-09-11)[2025-06-10]. https://decipher.uk.net/portfolio/the-adapt-study/.
[35]	赖鸿皓, 孙铭谣, 黄嘉杰, 等. 中西医结合临床实践指南实施框架构建的思考[J]. 协和医学杂志, 2023, 14(1):31-38.
	Lai HH, Sun MY, Huang JJ, et al. Development of the imple-mentation framework of integrative Chinese medicine clinical practice guideline[J]. Med J Peking Union Med Coll Hosp, 2023, 14(1):31-38.
[36]	Movsisyan A, Arnold L, Copeland L, et al. Adapting evidence-informed population health interventions for new contexts:a scoping review of current practice[J]. Health Res Policy Syst, 2021, 19(1):13. DOI
[37]	Walton H, Spector A, Roberts A, et al. Developing strategies to improve fidelity of delivery of,and engagement with,a complex intervention to improve independence in dementia:a mixed methods study[J]. BMC Med Res Methodol, 2020, 20(1):153. DOI PMID
[38]	Yamatani H, Mann A, Feit M. Avoiding type III, IV,and V errors through collaborative research[J]. J Evid Based Soc Work, 2013, 10(4):358-364. DOI PMID
[39]	Slaughter SE, Hill JN, Snelgrove-Clarke E. What is the extent and quality of documentation and reporting of fidelity to implementation strategies:a scoping review[J]. Implement Sci, 2015, 10:129. DOI PMID
[40]	郭晓凡, 刘金龙, 俞伊莉, 等. 基于人工智能的临床决策支持系统在ICU中应用的范围综述[J]. 中华护理杂志, 2025, 60(23):2933-2939. DOI
	Guo XF, Liu JL, Yu YL, et al. Application of artificial intelligence-based clinical decision support systems in ICU:a scoping review[J]. Chin J Nurs, 2025, 60(23):2933-2939.
[41]	Dusenbury L, Brannigan R, Falco M, et al. A review of re-search on fidelity of implementation:implications for drug abuse prevention in school settings[J]. Health Educ Res, 2003, 18(2):237-256. DOI PMID
[42]	王兰, 刘翠翠, 赵志娇, 等. 精神科护理组织氛围对护士工作疏离感影响的路径分析研究[J]. 中华护理杂志, 2025, 60(19):2397-2403. DOI
	Wang L, Liu CC, Zhao ZJ, et al. A path analysis study on the relationship between the nursing organizational climate and work alienation among psychiatric nurses[J]. Chin J Nurs, 2025, 60(19):2397-2403. DOI
[43]	Blom JW, Muth C, Glasziou P, et al. Describing deprescribing trials better:an elaboration of the CONSORT statement[J]. J Clin Epidemiol, 2020, 127:87-95. DOI URL

实施性研究中实施保真度的研究进展及启示

Research progress and implications of implementation fidelity in implementation research

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