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Primary Submission Category: Interventions/Programs
Building Trust Through Practice Facilitation: What Fidelity Data May Reveal About Influence in Population Health Improvement
Authors: Demetria Hubbard, Olakunle Alonge, Anne Brisendine, Larry Hearld, Kimberly Smith, Andrea Cherrington, Matthew Fifolt,
Presenting Author: Demetria Hubbard*
As population health initiatives increasingly rely on primary care to deliver evidence-based care, building trust in scientific evidence among frontline practices is essential. Yet little empirical work examines how implementation processes may contribute to the development of trust in these initiatives. This study used practice facilitation (PF) fidelity data to examine how patterns of PF delivery shaped adherence to improvement efforts and, theorize how adherence may contribute to credibility of interventions in real-world settings.
We analyzed data from 45 primary care practices participating in a statewide cardiovascular health improvement initiative. Fidelity was measured using a composite adherence score and indicators of facilitation “dose,” including frequency, mode, and total time spent between facilitators and practices over 12 months. We also examined organizational characteristics, including the role of the designated practice champion.
Adherence to different PF activities was moderate, but total adherence was uncommon. Practices that spent more total time with facilitators and had more in‑person or virtual interactions demonstrated higher adherence, while email contact alone was not associated with adherence. In addition, practices with champions embedded in day‑to‑day clinic operations showed higher adherence than those relying on more distant leadership roles.
Although trust was not directly measured, the observed associations between relational intensity, mode of facilitation, and local leadership roles are consistent with theorized pathways through which trust and credibility in evidence-based population health initiatives may be built. These findings suggest that implementation data can offer insight into the processes that support sustained engagement and influence in real-world settings. Explicit measurement of trust should be a priority for future population health research seeking to strengthen the relevance and impact of scientific evidence.