Fidelity, Adherence and Robustness of Interventions

An issue in mental health services research is how well an intervention of demonstrated efficacy works when applied under less-than-ideal conditions in practice settings. Most implementation studies have not systematically assessed important deviations from ideal protocols that commonly occur and their impacts on outcomes. This commentary was motivated in part by recent work in quality engineering that addresses similar issues in designing consumer products, and uses experimental and statistical methods such as robust parameter design to achieve good performance under representative user conditions. The authors believe that research on mental health interventions can benefit from such techniques.