Adaptation of evidence-based interventions in violence prevention: Are fidelity and flexibility compatible?

Background: To achieve population-level impact on violence outcomes, evidence-based interventions (EBIs) need to be widely disseminated, adopted and successfully implemented. Implementation success has been described as balancing fidelity to the original implementation with adaptations that increase an EBI's fit to local contexts. One challenge in gauging how this balance is negotiated in practice is that most studies include only researcher perspectives; few include the perspectives of program implementers, or examine common types of adaptations and the reasons practitioners make them. This presentation will frame fidelity and adaptation within violence prevention, discuss how these concepts apply to different types of interventions and discuss findings from a qualitative study aimed at clarifying perspectives of three stakeholders involved in violence prevention EBI dissemination: developers, implementers and technical assistance providers. Methods: To achieve study aims we conducted: 1) a comprehensive literature review, and 2) interviews and focus groups with intervention developers, implementers, and technical assistance (TA) providers supporting EBIs in child maltreatment, intimate partner and youth violence. We conducted content and thematic analyses and examined perspectives across groups. Results: Adaptations are often made in response to organizational capacity, implementation settings and participant needs. We will present common types of adaptations and how developers, implementers and TA providers view these adaptations with respect to implementation fidelity and desired outcomes. Conclusion: Successful dissemination of violence prevention EBIs in practice may require adaptations to local settings. Establishing feedback loops between developers and implementers may facilitate quality adaptations, increase implementation success and help developers improve the intervention.