Online Program

A mixed-method analysis of implementer perspectives on adaptations to an evidence-based intervention for teen dating violence prevention

Tuesday, November 5, 2013 : 4:50 p.m. - 5:10 p.m.

Deborah Gibbs, MSPH, Health and Well-Being of Women, Children and Families Program, RTI International, Research Triangle Park, NC
Stacey Cutbush, MA, Crime, Violence and Justice Family Research Program, RTI International, Research Triangle Park, NC
Kathleen Krieger, MPH, Women, Children, and Families Program, RTI, Research Triangle Park, NC
Monque Clinton-Sherrod, PhD, Risk Behavior and Family Research Program, RTI International, Research Triangle Park, NC
Shari Miller, PhD, Crime, Violence and Justice Family Research Program, RTI International, Research Triangle Park, NC
Background. Efforts to implement evidence-based interventions (EBIs) are often challenged by tension between program fidelity and desire by those who implement EBIs to adapt them to local context. Planned adaptation approaches attempt to anticipate needed adjustments and identify allowable modifications. Yet implementers still perceive a need to adapt to characteristics of program participants and setting in order to achieve intended outcomes. Notwithstanding the value of fidelity, there exists a need to better understand how reflective implementers assess context and make adjustments. Methods. Data are from 11 sites participating in the Start Strong Initiative, a community-based initiative to promote healthy relationships and prevent teen dating violence among middle-school aged students. All Start Strong sites implemented evidence-based curricula, in addition to other program components. We conducted a web-based survey, in-depth interviews, and an online focus group with site coordinators and those implementing curricula. Results. Implementers offered numerous examples in which curriculum was adjusted [to better achieve intended outcomes, weighing the potential value of adjustments against threats to fidelity. Implementers described rationales, methods and outcomes for adjustments made. Adjustments were made to both content and pedagogy, and responded to concerns about comprehension, relevance, resonance, culture, social maturity, student culture and logistics. They described adjustments as improving the curriculum's fit to their context and improving their ability to achieve intended outcomes. Conclusions. Explicating implementers' assessments of implementation and adjustments can offer valuable perspectives on challenges to EBI fidelity. Results can inform strategies to support implementer-informed adaptation processes that are consistent with EBI goals.

Learning Areas:

Implementation of health education strategies, interventions and programs
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Explain the tension between maintaining program fidelity and wanting a program to fit with a local context. Describe the factors considered by implementers in determining whether adjustments are made. Identify the types of adjustments made by implementers. Describe how implementers’ perspectives can inform guidance on making quality adaptations.

Keyword(s): Interventions, Adolescents

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As Principal Investigator for the study, Adaptation and Implementation Issues for Evidence Based Programs in Teen Dating Violence Prevention, I have directed and participated in all planning, data collection and analysis of the data being presented.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.