An Empirical Assessment of Implementation, Adaptation, and Tailoring: The Evaluation of CDC's National Diffusion of VOICES/VOCES

Abstract

The Centers for Disease Control and Prevention (CDC), through its Diffusion of Effective Behavioral Interventions (DEBI) program, trained over 260 agencies on VOICES/VOCES between August 2003 and April 2005. ORC Macro conducted interviews with agency staff 3 months after receiving VOICES/VOCES training. This article discusses the diffusion of VOICES/VOCES; agencies' adoption, adaptation, and implementation of this intervention; and needs for ongoing proactive technical assistance (TA) for agencies to successfully integrate behavioral interventions into their programs. The vastmajority of agencies implemented VOICES/VOCES with fidelity to the core elements, and agencies successfully adapted the intervention to make it more appealing to target populations. TA is needed for interventions to be successfully adapted and implemented with fidelity to the core elements, and to ensure program sustainability. More effective interventions of short duration and minimum complexity to easily match with existing resources and conditions of agency capacity among HIV prevention providers in the community are needed.

Fiscal loss and program fidelity: impact of the economic downturn on HIV/STI prevention program fidelity

“…Prior work examining HIV program fidelity has identified a number of fidelity challenges at the program level (e.g., training, client fit, procedural fit) [13,14,17,[24][25][26][27][28][29]. However, past studies have not examined how agencies adapt to economic strains and the influence of those adaptations on program fidelity.…”

The HIV Epidemic: High-Income Countries

“…Behavior change remains a backbone of interventions in higher-income nations, although results have been somewhat disappointing as with Project EXPLORE/HIVNET 015 Koblin et al 2003Koblin et al , 2004Colfax et al 2004Colfax et al , 2005Salomon et al 2009). Combination interventions are now being explored (Barrow et al 2008;Corsi and Booth 2008;Buchbinder 2009;Rotheram-Borus et al 2009;Burns et al 2010;Cohen et al 2010;Crawford and Vlahov 2010;DeGruttola et al 2010;El-Bassel et al 2010;Read 2010;Reynolds and Quinn 2010), as are behavioral approaches with a better base in evidence Harshbarger et al 2006;Lyles et al 2006;Wingood and DiClemente 2006;Margaret Dolcini et al 2010). One strategy has been a conspicuous failure, namely "abstinence only" education, discovered to be associated with higher pregnancy rates than more comprehensive approaches that also highlighted STD prevention with condom use (Ott and Santelli 2007;Kohler et al 2008;Trenholm et al 2008).…”

Evaluation of an HIV Prevention Intervention for African Americans and Hispanics: Findings from the VOICES/VOCES Community-Based Organization Behavioral Outcomes Project

“…One issue to consider is that CBO implementation may differ significantly from intervention implementation in the original efficacy trials. For example, although the majority of agencies funded by CDC to deliver VOICES/VOCES have reported adherence to the intervention's core elements (i.e., key components of the intervention that are most likely to produce intended outcomes), 41% of agencies reported delivery to audiences for whom the intervention was not originally designed and tested in research trials [24]. Additionally, EBIs may be adapted in a variety of ways by local providers depending on agency resources and the needs of the populations served by the agency.…”