As already mentioned, the interplay between a policy or intervention and the context within which it is implemented is complex. Various moderating factors – moderators – can affect the fidelity with which a policy or intervention is implemented; the effect can be positive or negative. Moreover, these moderators interact with each other, and the effect of one moderator on fidelity might be influenced by another moderator.
Factors identified as potential moderators of effective programme implementation include: complexity of the intervention, facilitation strategies, quality of delivery, consumer characteristics and responsiveness(81, 84, 85) as well as individual practitioner characteristics,(86-88) organizational supports for innovation(19, 96, 100) and implementation support strategies.(64, 86, 87) Active and integrated approaches by those developing/supporting the implementation process(15, 64) and the broader context may also influence implementation.(89-91) Therefore, social systems, interorganizational linkages and historical/concurrent events should be taken into account when assessing programme implementation.(89)