public health- implementation and dissemination science
Answer the following question based of the article : Gonzalez Castro, F. Barrera, M., and Martinez, C.R. (2004).
The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit. Prevention Science
(5):1. ( article attached)
1.What are the implications, if any, of testing culturally adapted versions of a model prevention program against its original version, with respect to the validation group and the current consumer group? Additionally, I’d like you to consider how the perceived attributes of Diffusion of Innovations can play a role in the balancing act of fidelity and fit.
Answer the following questions based of the article: Fixsen, D. L., Blase, K. A., Naoom, S. F., & Wallace, F. (2009).
Core implementation components.
Research on Social Work Practice,
19(5), 531–540 ( article attached)
1. What are core components and why are they an important consideration in program implementation?
2. What is an example of how implementers can operationalize their core components?
Answer the following question based of the article : Gonzalez Castro, F. Barrera, M., and Martinez, C.R. (2004). The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit. Prevention Science (5):1. ( article attached) 1.What are the implications, if any, of testing culturally adapted versions of a model prevention program against its original version, with respect to the validation group and the current consumer group? Additionally, I’d like you to consider how the perceived attributes of innovations can play a role in the balancing act of fidelity and fit. Answer the following questions based of the article: Fixsen, D. L., Blase, K. A., Naoom, S. F., & Wallace, F. (2009). Core implementation components. Research on Social Work Practice, 19(5), 531–540 ( article attached) 1. What are core components and why are they an important consideration in program implementation? 2. What is an example of how implementers can operationalize their core components? The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit P1: JQX Prevention Science [PREV] pp1100-prev-480029 January 21, 2004 12:47 Style file version Nov. 04, 2000 Prevention Science, Vol. 5, No. 1, March 2004 ( C© 2004) The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit Felipe González Castro,1,3 Manuel Barrera, Jr.,1 and Charles R. Martinez, Jr.2 A dynamic tension has developed in prevention science regarding two imperatives: (a) fi- delity of implementation—the delivery of a manualized prevention intervention program as prescribed by the program developer, and (b) program adaptation—the modification of pro- gram content to accommodate the needs of a specific consumer group. This paper examines this complex programmatic issue from a community-based participatory research approach for program adaptation that emphasizes motivating community participation to enhance program outcomes. Several issues, key concepts, and implementation strategies are presented under a strategic approach to address issues of fidelity and adaptation. Despite the noted tension be- tween fidelity and adaptation, both are essential elements of prevention intervention program design and they are best addressed by a planned, organized, and systematic approach. Towards this aim, an innovative program design strategy is to develop hybrid prevention programs that “build in” adaptation to enhance program fit while also maximizing fidelity of implementation and program effectiveness. KEY WORDS: cultural adaptation; community-based participatory research. INTRODUCTION At a coalition meeting in a small traditional com- munity in the Southwest, a concerned community leader stated, “Para que sirve la ciencia, si no nos ayuda?” In English, this means, “What good is sci- ence, if it doesn’t help us?” This challenge to preven- tion science highlights the need to develop culturally informed and responsive programs that deliver the best science while also addressing the practical con- cerns of a local community. This paper examines criti- cal issues regarding this existing tension, especially as it affects communities of color: racial/ethnic minority groups and members of other special populations. The fidelity-adaptation tension involves two competing aims: (a) to develop universal prevention interventions and implement them with fidelity, 1Department of Psychology, Arizona State University, Tempe, Arizona. 2Oregon Social Learning Center, Eugene, Oregon. 3Correspondence should be directed to Felipe González Castro, Department of Psychology, Arizona State University, Tempe, Arizona 85287-1104; e-mail:
[email protected]. and (b) to design prevention interventions that are responsive to the cultural needs of a local community. By implication, prevention interventions that are “culturally blind” will fail to prompt community participation, likely eroding program outcome ef- fects (Kumpfer et al., 2002). Conversely, a culturally focused prevention intervention may be culturally appealing thus prompting consumer participation, although cultural appeal if unscientific will not guarantee program effectiveness. Nonetheless, some form of program adaptation is a pervasive practice within communities nationwide (see Ringwalt et al., 2004), and prevention science must offer science- based strategies that regulate adaptation to avoid decrements in effectiveness based on haphazard or inappropriate program adaptations. The ideal strat- egy is to design an effective science-based prevention intervention that is also culturally relevant. Adaptation for Racial/Ethnic Communities The program adaptation approach has emer- ged from community-based health promotion, that 41 1389-4986/04/0300-0041/1 C© 2004 Society for Prevention Research P1: JQX Prevention Science [PREV] pp1100-prev-480029 January 21, 2004 12:47 Style file version Nov. 04, 2000 42 Castro, Barrera, and Martinez emphasizes community-based participation in pro- gram planning, evaluation, and research (Flores et al., 1995; Minkler & Wallerstein, 2003a). Effec- tive community-based program design often involves both “top–down” (social planning) and “bottom– up” (locality development) approaches (Minkler & Wallerstein, 2003b). The top–down approach incor- porates scientific experts in program design, whereas the bottom–up “grass roots” approach involves mobi- lizing community to address a common public health concern. Community adoption of a program and its lo- cal adaptation are enhanced by community ownership or “buy-in” to motivate and sustain local community participation. Moreover, acculturation, assimilation, and cultural change are significant concerns among immigrant and racial/ethnic populations (National Alliance for Hispanic Health, 2001), wherein the loss of traditional cultural practices and family supports may compromise the resilience exhibited by some unacculturated populations (Alderate et al., 2000; Table 1. Sources of Program Mismatch Source of mismatch Program validation group(s) Current consumer group Actual or potential mismatch effect Group characteristics Language English Spanish Consumer inability to understand program content; a major adaptation issue Ethnicity White, nonminority Ethnic minority Conflicts in beliefs, values and/or norms; reactance Socioeconomic status Middle class Lower class Insufficient social resources and culturally different life experiences Urban–rural context Urban inner city Rural, reservation Logistical and environmental barriers affecting participation in program activities Risk factors: Number and severity Few and moderate in severity Several and high in severity Insufficient effect on multiple or most severe risk factors Family stability Stable family systems Unstable family systems Limited compliance in program attendance and participation Program delivery staff Type of staff Paid program staff Lay health workers Lesser or different program delivery skills and perspectives Staff cultural competence Culturally competent staff Culturally insensitive staff Limited awareness of, or insensitivity to cultural issues Staff cultural competence Culturally insensitive staff Culturally competent staff Staff will refer to missing cultural elements and criticize the program for being culturally insensitive or unresponsive; misadaptation Admin/community factors Community consultation Consulted with community in program design and/or administration Not consulted with community Absence of community “buy in,” community resistance or disinterest and low participation Community readiness Moderate readiness Low readiness Absence of infrastructure and organization to address drug abuse problems and to implement the program Martinez et al., 2003). Further research is needed to understand these putative protective mechanisms to incorporate them into culturally informed prevention programs that benefit minority communities. The Ecodevelopmental Model and related culturally oriented systems models may aid in this effort (Szapocznik & Coatsworth, 1999). Addressing Program-Community Mismatch Currently, the SAMHSA/CSAP National Reg- istry of Effective Prevention Programs lists 44 model programs that have been rigorously reviewed and evaluated as science-based effective programs and over half of these have received some form of program adaptation (Schinke et al., 2002). Nonetheless, model programs having program activities that conflict with local participant needs are culturally mismatched and may require program adaptation. Table 1 presents contrasting conditions between the group used to P1: JQX Prevention Science [PREV] pp1100-prev-480029 January 21, 2004 12:47 Style file version Nov. 04, 2000 Cultural Adaptation of Prevention Interventions 43 validate a prevention program, the validation group, and the current consumer group, where sources of nonfit and “mismatch effect,” would threaten pro- gram efficacy, despite high fidelity in program imple- mentation. Major sources of mismatch are: (a) group characteristics, (b) program delivery staff, and (c) ad- ministration/community factors. When present, these sources of mismatch should be addressed in an a- priori strategic plan for program adaptation that pre- cedes program implementation. The primary aim in cultural adaptation is to generate the culturally equivalent version of a model prevention program. Table 1 shows how significant differences between a program’s validation group and a current consumer group or community can yield a specific mismatch effect. Beyond adaptation focused on race or ethnicity, nonfit can also involve other types of ecological factors (see Table 1). For example, a model prevention program developed and validated primarily with urban White middle class youth may lack fit and relevance by not addressing significant issues that greatly affect Appalachian youth, issues that include: limited growth opportunities for them within an impoverished rural community, the stres- sors and obligations of traditional kinship ties, and the stressors of urban–rural acculturation conflicts (Wilson & Peterson, 2000). Attention to these local life issues that may increase the risk of substance use among Appalachian youth would likely increase program relevance and appeal, while in principle also increasing program participation and effectiveness. CULTURALLY INFORMED RESEARCH APPROACHES Some Guidelines for Program Adaptation to Promote Efficacy and Effectiveness Recently a set of program adaptation guidelines has been proposed (Backer, 2001), which emphasizes balancing program fidelity and adaptation as a best strategy for improved prevention program outcomes. This proposed 12-step approach recognizes the con- troversies and complexities involved in attaining this balance. This approach is dynamic, evolves over time, and is based on a logic model that aims to preserve a program’s core components, while also making adaptations that facilitate program effectiveness within the local environment. This “Finding the Balance,” guide for program fidelity and adaptation (Backer, 2001) consists of the following 12 steps: (a) define the fidelity/adaptation balance; (b) assess community concerns; (c) review a targeted program to determine fidelity/adaptation is- sues; (d) examine that program’s theory of change, logic model, and core components; (e) determine the needed resources; (f) consider available training; (g) consider how to document adaptation efforts; (h) consult with the program developer; (i) involve the community; (j) integrate all prior steps into a plan; (k) include fidelity/adaptation issues into the program evaluation; and (l) conduct an ongoing analysis of fi- delity/adaptation issues. Moreover, these steps should be conducted under a rigorous scientific testing and evaluation of the modified program, to ensure that the adapted program is as effective as the original program. Specific Elements of a Program Adaptation Framework Cultural Adaptation Cultural adaptation refers to program modifi- cations that are culturally sensitive and tailored to a cultural group’s traditional world views (Kumpfer et al., 2002). Cultural adaptations must move beyond surface structure (changing the ethnicity or the appearance of role models), to deep structure, by addressing the core values, beliefs, norms, and other more significant aspects of the cultural group’s world views and lifestyles (Resnikow et al., 2000). Effective cultural adaptation also involves understanding and working effectively with cultural nuances (Castro, 1998) and requires cultural competence among pro- gram developers, among those adapting the program, and among program delivery staff (Skaff et al., 2002). Dimensions of Adaptation Adaptation that is guided by a sound con- ceptual framework will aid in effectively resolving program-consumer nonfit. Important dimensions to guide adaptation strategies include: (a) Cognitive- information