How can you assure fidelity when you adapt evidence-based programs to your community?

Older Americans are disproportionately affected by chronic diseases and disabilities. Several health education programs, like EnhanceFitness (EF) from Seattle and the Chronic Disease Self Management Program (CDSMP) from Stanford, have proven effective in reducing older people's risk of disease, disability and injury. But evidence-based programs may have to be adapted to fit a new community. How can you assure fidelity when you adapt evidence-based programs? The purpose of this paper is to describe fidelity-assurance processes established for Hawai‘i's Healthy Aging Program as it adapted EF and CDSMP to Hawai‘i seniors. Processes include: 1) the deconstruction of the evidence-based program using a tracking-changes tool; 2) a step-by-step plan for program replication, documenting areas in need of adaptation; 3) negotiation with the parent program on red-light, yellow-light, and green-light adaptations; 4) excellent training to local staff who will deliver the programs; 5) monitoring by supervisory and evaluation staff using standardized checklists; and 6) comparison of data with that of the parent program to assure that clients are making expected gains. We will present our experience with using this 6-step protocol as we implemented EF in Hawai`i. Forms also will be shared. This session will be useful to programmers and evaluators who are helping organizations replicate evidence-based programs in their communities.