Examining Adaptations of Evidence-Based Programs in Natural Contexts

Abstract

When evidence-based programs (EBPs) are scaled up in natural, or non-research, settings, adaptations are commonly made. Given the fidelity-versus-adaptation debate, theoretical rationales have been provided for the pros and cons of adaptations. Yet the basis of this debate is theoretical; thus, empirical evidence is needed to understand the types of adaptations made in natural settings. In the present study, we introduce a taxonomy for understanding adaptations. This taxonomy addresses several aspects of adaptations made to programs including the fit (philosophical or logistical), timing (proactive or reactive), and valence, or the degree to which the adaptations align with the program's goals and theory, (positive, negative, or neutral). Self-reported qualitative data from communities delivering one of ten state-funded EBPs were coded based on the taxonomy constructs; additionally, quantitative data were used to examine the types and reasons for making adaptations under natural conditions. Forty-four percent of respondents reported making adaptations. Adaptations to the procedures, dosage, and content were cited most often. Lack of time, limited resources, and difficulty retaining participants were listed as the most common reasons for making adaptations. Most adaptations were made reactively, as a result of issues of logistical fit, and were not aligned with, or deviated from, the program's goals and theory.

Adaptations in a Community-Based Family Intervention: Replication of Two Coding Schemes

“…Facilitators have also reported deleting activities due to insufficient time to complete them or changing delivery styles because they believed that a different format or process would be better. Disagreement with content, clarification of or emphasis on specific content, and technical difficulties have also been reported as common reasons for adaptations (Cohen et al, 2008;Hill, Maucione, & Hood, 2007;Miller-Day et al, 2013;Moore et al, 2013;Ozer, Wanis, & Bazell, 2010). Our study aims to extend our knowledge of types of and reasons for program adaptation in community settings through the replication of two multidimensional coding systems.…”

“…The primary adaptation types reported in those few studies are changes to program content, format, and delivery context. Studies also commonly report that facilitators provide additional information or resources; change the program's target population; add rewards, prizes, or celebrations; and modify training or evaluation processes (Cohen et al, 2008;Lara et al, 2011;Miller-Day et al, 2013;Moore, Bumbarger, & Cooper, 2013;Stirman, Miller, Toder, & Calloway, 2013;Veniegas, Kao, & Rosales, 2009).…”

The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care

“…Some research suggests that adaptation is likely necessary to promote sustainability (7,8,23), although other studies suggest that certain types of adaptation decrease the benefits associated with the intervention (68, 128). What is currently known, though, is that although high fidelity has been associated with positive program outcomes (34), adaptation is fairly common (3,86,125,150) and often necessary.…”

“…Some research suggests that adaptation is likely necessary to promote sustainability (7,8,23), although other studies suggest that certain types of adaptation decrease the benefits associated with the intervention (68, 128). What is currently known, though, is that although high fidelity has been associated with positive program outcomes (34), adaptation is fairly common (3,86,125,150) and often necessary.It is important to consider that some adaptations are not deviations from the original effective components of the program and may be beneficial (11,21,22,148). For example, there is evidence that family-based interventions to reduce substance use reach more minority participants if they are adapted to fit local culture and context (e.g., to reflect sociocultural values of Hispanic populations and rural settings) (59,69,82).…”

Leveraging Research and Philanthropy to Reduce Crime and Violence in the Mississippi Delta

“…As noted in the previous chapter, many of the evidencebased programs have not been implemented in areas similar to the Mississippi Delta, so they may need to be adapted. There is a lot of research on how evidence-based programs can be altered, such as Rural Health Information Hub (Rural Health Information Hub, undated) and DHHS Family and Youth Services Bureau (Family and Youth Services Bureau, undated), and relevant academic literature (Chen et al, 2013;Moore, Bumbarger, and Cooper, 2013;Smith and Caldwell, 2007).…”