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When using health IT tools to deliver patient-centered health messages, systems-level requirements are often at odds with \u2018on-the ground\u2019 tailoring approaches for patient-centered care or ensuring equity among linguistically diverse populations.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted a fidelity and acceptability-focused evaluation of the STAR MAMA Program, a 5-month bilingual (English and Spanish) intervention for reducing diabetes risk factors among 181 post-partum women with recent gestational diabetes. The study\u2019s purpose was to explore fidelity to pre-determined \u2018core\u2019 (e.g. systems integration) and \u2018modifiable\u2019 equity components (e.g. health coaching responsiveness, and variation by language) using an adapted implementation fidelity framework. Participant-level surveys, systems-level databases of message delivery, call completion, and coaching notes were included.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>96.6% of participants are Latina and 80.9% were born outside the US. Among those receiving the STAR MAMA intervention; 55 received the calls in Spanish (61%) and 35 English (39%). 90% (n\u2009=\u200981) completed\u2009\u2265\u2009one week. Initially, systems errors were common, and increased triggers for health coach call-backs. Although Spanish speakers had more triggers over the intervention period, the difference was not statistically significant. Of the calls triggering a health coach follow-up, attempts were made for 85.4% (n\u2009=\u2009152) of the English call triggers and for 80.0% (n\u2009=\u2009279) of the Spanish call triggers (NS). Of attempted calls, health coaching calls were complete for 55.6% (n\u2009=\u200985) of English-language call triggers and for 56.6% of Spanish-language call triggers (NS). Some differences in acceptability were noted by language, with Spanish-speakers reporting higher satisfaction with prevention content (<jats:italic>p<\/jats:italic>\u2009=\u2009&lt;\u20090.01) and English-speakers reporting health coaches were less considerate of their time (<jats:italic>p<\/jats:italic>\u2009=\u20090.03).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>By exploring fidelity by language-specific factors, we identified important differences in some but not all equity indicators, with early systems errors quicky remedied and high overall engagement and acceptability. Practice implications  include: (1) establishing criteria for languge-equity in interventions, (2) planning for systems level errors so as to reduce their impact between language groups and over time; and (3) examining the impact of engagement with language-concordant interventions on outcomes, including acceptability.<\/jats:p>\n                <jats:p><jats:italic>Trial Registration<\/jats:italic> National Clinical Trials registration number: CT02240420 Registered September 15, 2014. ClinicalTrials.gov.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12911-021-01476-z","type":"journal-article","created":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T12:03:19Z","timestamp":1617796999000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["What matters when exploring fidelity when using health IT to reduce disparities?"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5034-2111","authenticated-orcid":false,"given":"Margaret A.","family":"Handley","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerad","family":"Landeros","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cindie","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana","family":"Najmabadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Vargas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priyanka","family":"Athavale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,4,7]]},"reference":[{"issue":"1","key":"1476_CR1","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s12874-018-0496-8","volume":"18","author":"UVT Schwarz","year":"2018","unstructured":"Schwarz UVT, F\u00f6rberg U, Sundell K, Hasson H. 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