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Table 1 Summary of FHLS Components

From: Factors contributing to intervention fidelity in a multi-site chronic disease self-management program

FHLS components Description Adaptation
Health educator recruitment Placed ads in local newspapers; set minimal qualifications as health education experience. Employed well-connected individuals from the local community with less than minimal qualifications.
Patient recruitment Patient recruitment led by physicians or self-referral from clinic recruitment posters. Clipped patient eligibility referral sheets to medical charts to prompt physician recruitment efforts.
Patient incentives Incentives included a tote bag, glucose monitors and strips, and/or blood pressure monitor. Incentives remained the same throughout the implementation.
Class sessions Set curriculum. Natural variation of teaching style using suggested curriculum.
Program materials Posters, brochures, workbooks, low-literacy format, flipcharts for diabetes and hypertension, incentives (magnets, calendars, tote bags, medication pill box, medication compliance worksheet, food sheets). All program materials were used and appreciated by patients and clinic staff. A few health educators enhanced materials, even though it was discouraged by project staff. Translated materials according to various Spanish-speaking cultures.
Program manuals Developed by project staff and used in all clinic sites for standardized training and implementation. The clinic training schedule was adapted to the needs of each clinic site.
Patient retention and follow-up 6 month commitment from patients. Scheduled patient's health education appointments in conjunction with medical appointments.
Technical assistance Offered support to health educators via e-mail or telephone, as needed. Need for daily support to health educators was much greater than anticipated by project staff.
Staff incentives Not included in the original design. Frequently requested to increase staff buy-in.