Issues in Disseminating and Replicating Effective Prevention Programs

Abstract

The new frontier for prevention research involves building a scientific knowledge base on how to disseminate and implement effective prevention programs with fidelity. Toward this end, a brief overview of findings from the Blueprints for Violence Prevention-Replication Initiative is presented, identifying factors that enhance or impede a successful implementation of these programs. Findings are organized around five implementation tasks: site selection, training, technical assistance, fidelity, and sustainability. Overall, careful attention to each of these tasks, together with an independent monitoring of fidelity, produced a successful implementation with high fidelity and sustainability. A discussion of how these findings inform the present local adaptation-fidelity debate follows.

Predictors of subjective outcome evaluation findings in a positive youth development program in Hong Kong

“…In addition, other contextual factors (e.g., school and organization characteristics, provision and quality of implementer training, continual program support and monitoring, etc.) should also be considered as supported by program evaluation studies (58,59) . To maximize program effectiveness, a better understanding of how multiple factors interact with each other, and their combined effects on program effectiveness is needed in future research.…”

Worldwide application of prevention science in adolescent health

“…89 Advocates of strict implementation fidelity highlight evidence that participant outcomes are stronger and sometimes only achieved when interventions are replicated as closely as possible to their original protocol. 90,91 Others contend that adaptations are needed to ensure that an intervention's content, language, examples, and methods of delivery are culturally appropriate and relevant to the new population. 92 This view anticipates that modifications will increase participant responsiveness, programme effectiveness, and sustainability.…”

“…Until that is possible, dissemination efforts can be fostered by better identification of the core elements of efficacious interventions-the content, activities, and modes of delivery that best represent their underlying logic and causal mechanisms. 91,93 Adopters must be aware of these principles and ensure their full implementation. 94 When planned adaptations of programme features substantially revise the intervention, rigorous assessment, perhaps comparing the unaltered intervention to the adaptation, should be done to ensure that the new version is effective.…”

Measuring the Value of Program Adaptation: A Comparative Effectiveness Study of the Standard and a Culturally Adapted Version of the Arthritis Self-Help Program

“…First, the benefits of program adaptation remain inadequately defined, despite claims that adapted programs are better received by participants. Second, although it is often assumed that program adaptation increases both the reach and utility of EBIs while maintaining their effectiveness, some advocates of program fidelity argue that program adaptation can threaten an EBI's effectiveness [8,12]. Therefore, it is of critical importance to evaluate the effectiveness of adapted programs using controlled research designs to ascertain whether there is maintenance of (or possibly loss in) a program's effectiveness.…”