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Evidence-Based Complementary and Alternative Medicine
Volume 2013, Article ID 652047, 11 pages
Research Article

When a Whole Practice Model Is the Intervention: Developing Fidelity Evaluation Components Using Program Theory-Driven Science for an Integrative Medicine Primary Care Clinic

1Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, P.O. Box 245153, Tucson, AZ 85724-5153, USA
2Health Unit, The RAND Corporation, Santa Monica, CA 90407-2138, USA
3Center for Health Outcomes & PharmacoEconomic Research (HOPE), College of Pharmacy, University of Arizona, P.O. Box 245153, Tucson, AZ 85724-5153, USA
4College of Nursing, University of Arizona, P.O. Box 245153, Tucson, AZ 85724-5153, USA

Received 30 July 2013; Accepted 9 October 2013

Academic Editor: Raheleh Khorsan

Copyright © 2013 Sally E. Dodds et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Integrative medicine (IM) is a clinical paradigm of whole person healthcare that combines appropriate conventional and complementary medicine (CM) treatments. Studies of integrative healthcare systems and theory-driven evaluations of IM practice models need to be undertaken. Two health services research methods can strengthen the validity of IM healthcare studies, practice theory, and fidelity evaluation. The University of Arizona Integrative Health Center (UAIHC) is a membership-supported integrative primary care clinic in Phoenix, AZ. A comparative effectiveness evaluation is being conducted to assess its clinical and cost outcomes. A process evaluation of the clinic’s practice theory components assesses model fidelity for four purposes: (1) as a measure of intervention integrity to determine whether the practice model was delivered as intended; (2) to describe an integrative primary care clinic model as it is being developed and refined; (3) as potential covariates in the outcomes analyses, to assist in interpretation of findings, and for external validity and replication; and (4) to provide feedback for needed corrections and improvements of clinic operations over time. This paper provides a rationale for the use of practice theory and fidelity evaluation in studies of integrative practices and describes the approach and protocol used in fidelity evaluation of the UAIHC.