After a community has carefully chosen and planned their prevention strategy, it is then time to implement the prevention program or programs. Implementation is the next step in the SPF process. At this stage it is important to think about the prevention program’s ‘active ingredients,’ or its goals, objectives, timeline, and protocols. It is likely that a program will need to be adapted to fit local conditions so as to be a good match for the cultural norms, values, and beliefs of a community. If an intervention is not seen as relevant to the target population, it is not likely to be effective. However, communities and organizations should be thoughtful and purposeful about the changes they make to their prevention programs. When making cultural adaptations to a program, changes need to be recorded and should not alter the features of the program that are thought to be the key ingredients for change.
When implementing culturally appropriate programs, service providers and planners often have to strike a balance between fidelity to the original program design and cultural adaptation.
- Adaptation: Any change a prevention program undergoes in order to meet specific needs. Two types of adaptation include changes to program content and delivery.
- 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., online vs. in the classroom).
- Fidelity: The degree that an implemented prevention program stays true to what its designers intended. Fidelity can be described along 4 dimensions:
- 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 that impact 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 dosage because it is possible that participants who attend more activities will show more change than those who left the program early.
- Quality of delivery: In the end, how 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.
- 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. (2019, June 20). A Guide to SAMSHA’s Strategic Prevention Framework. Retrieved from https://www.samhsa.gov/sites/default/files/20190620-samhsa-strategic-prevention-framework-guide.pdf