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Fidelity & Adaptation

Fidelity & Adaptation

Choosing the right prevention program is so important. Once chosen, it is critical that a program is implemented with fidelity to get the best possible outcomes. Fidelity refers to the degree that an implemented program stays ‘true’ to what its designers intended. Consider the following factors when attempting to faithfully replicate a prevention program. 

  • Adherence: How much did your program stick to the original design? It is not always possible or even desirable (in the case of cultural adaptations) to administer a program exactly as designed. However, it is important to note any deviations from the design to see if these have impacted your outcomes in some way.
  • Dose: How much of the program did your target population receive? This refers to the number of classes or meetings participants actually attended, as well as the length and intensity of the program activities. It is important to keep track of the dose because it is quite possible that participants who attended more activities will show more change than those who left the program early.
  • Quality of delivery: In the end, how high was the quality of your program delivery? This refers to the level of staffing and training as well as the resources deployed during program activities. It is possible to follow a program manual precisely but without a focus on the quality of the delivery. This is often the result of poor planning, inadequate training, or lack of enthusiasm on the part of program staff.
  • Participant responsiveness: How did your target population respond to the program? A successful prevention program is not only well-implemented with a high level of quality, but it is also relevant to your participants. If your program is not meaningful and useful to your target audience, then even high-quality implementation will result in disappointing outcomes. Therefore, measuring the level of participant engagement is critical to understanding whether a program is effective.

However, it is also important to remember that often programs need to be modified to better fit the target population and the setting in which they are implemented. These modifications are called adaptations. Adaptations can be very useful and can even be a critical component of program success, but they can also compromise the fidelity with which a program is implemented. It is, therefore, necessary to find the right balance between adaptation and implementation fidelity.

When choosing an evidence-based program (EBP), it is important to consider how a program will fit with the cultural values of your target population, as well as how it will fit with the setting and resources available for implementation. If a program does not make cultural sense to your target audience, then it is unlikely to be effective. For this reason, a program developed and empirically supported in one community simply may not work in another. Additionally, a program needs to be feasible and practical in your specific setting to be implemented effectively.

However, it is possible that no one EBP is a perfect match for your situation. When this happens, it is often necessary to modify an existing program to better fit your needs.

  • Adaptation refers to any change a prevention program undergoes to meet specific needs. Adaptation can include two types of changes to programs:
  • Content: Making changes or additions to program manuals, tasks, and tools so that the content is more relevant to the target population. In order to be effective, these changes should reflect the use of both culturally-relevant names, terms, and examples (surface structure) and culturally-relevant concepts, themes, and issues (deep structure).
  • Delivery: Making changes to the way programs are carried out (e.g., methods, online, or in the classroom)

 Most programs are characterized by a set of "key ingredients" which are thought to be the main catalysts of program effectiveness. The rest of the program surrounds and supports these key ingredients. When making modifications to a program it is important to identify and keep the "key ingredients" in order to maintain program effectiveness. However, often other facets of the program can be changed without significantly diminishing program effectiveness. When changes are made to a program it is critical that they are recorded and monitored so that you can later understand if they had some major effect on the intended outcomes. Well-designed adaptations can actually increase the effectiveness of your program.

 

References

Castro, F., Barrera, M., and Martinez, C. (2004). The cultural adaptation of prevention interventions: resolving tension between fidelity and fit. Prevention Science, 5(1), 41-45.
 
Dusenbury, L., Brannigan, R., Falco, M., and Hansen, W. (2003). A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Education Research Theory & Practice, 18(2), 237-256. 
 
Moncher, F., and Prinz, R. (1991). Treatment fidelity in outcome studies. Clinical Psychology Review, 11, 247-266.
 
SAMHSA. (2015, October 1). Step 4: Implement. Retrieved from http://www.samhsa.gov/capt/applying-strategic-prevention-framework/step4-implement
Castro, F., Barrera, M., and Martinez, C. (2004). The cultural adaptation of prevention interventions: resolving tension between fidelity and fit. Prevention Science, 5(1), 41-45.
 
Resnicow, K., Baranowski, T., Ahluwalia, J.S., and Braithwaite, R.L. (1999). Cultural sensitivity in public health: defined and demystified. Ethnicity and Disease, 9 (1), 10-21.
 
SAMHSA. (2015, September 25). Cultural Competence. Retrieved from http://www.samhsa.gov/capt/applying-strategic-prevention/cultural-competence

September 2020

Sep 10 Thu
Maui Opioid Series Part 1: The History of the Opioid Epidemic

This virtual training, "The History of the Opioid Epidemic," is part one of a four-part opioid series. This training will inform participants on the opioid timeline in the US and discuss events that led to the "perfect storm" that created the opioid epidemic. The training will present the burden of opioid use in the wider US, and will also present local data on opioid use in Hawai‘i.

Location

Zoom

Sep 16 Wed
Maui Opioid Series Part 2: Opioid Overdose Prevention & Response

This FREE virtual training, "Taking Action on Opioids," is part two of a four-part opioid training series.
This training will focus on ways communities can take action to address the opioid crisis. The training will discuss ways communities can collaborate across sectors to prevent and reduce the harmful consequences of opioid misuse in the community. The training will also discuss effective strategies to address the problem, and local networks and resources already available.

Location

Zoom

Sep 17 Thu
Maui Opioid Series Part 3: Taking Action on Opioids

This FREE virtual training, "Taking Action on Opioids," is part two of a four-part opioid training series.
This training will focus on ways communities can take action to address the opioid crisis. The training will discuss ways communities can collaborate across sectors to prevent and reduce the harmful consequences of opioid misuse in the community. The training will also discuss effective strategies to address the problem, and local networks and resources already available.

Location

Zoom

Sep 24 Thu
Maui Opioid Series Part 4: Non-Opioid Alternatives to Pain Management

This FREE virtual training, "Non-Opioid Alternatives to Pain Management" is part four of a four-part opioid training series.
This training will explore the various evidence-based non-opioid alternatives to pain management recommended by the Centers for Disease Control and Prevention (CDC). Most of the training will focus on non-pharmacological options for that have evidence to support their effectiveness at helping individuals manage pain. Participants will learn about the risks associated with the use of opioids for pain and identify alternative treatments supported by the CDC.

Location

Zoom