Transcript PowerPoint-presentatie

Adapting
an Evidence-based Approach
to Fit Your Community
Where do We Stand?
Assessing your
Community
Establishing
Goals &
Objectives;
Planning for
Evaluation
Finding
Evidence
Selecting Best
Fitting EBAs
Adapting
Implementing &
Evaluating
Session Objectives
• Define adaptation, fidelity, and core elements
• Describe the process and steps for adaptation
• Discuss which changes can probably be made
without affecting the effectiveness vs. which
cannot
Adaptation
Adaptation: making changes or modifications to fit
priority population and local conditions
• Additions
• Deletions
• Substitutions
Fit and Fidelity
Adaptation is a balance between:
Achieving FIT – Make an EBA compatible
with your community
Maintaining FIDELITY – Optimize
implementation of an EBA as it is
prescribed in the original protocol.*
*Rabin, B.A., Brownson, R.C., Haire-Joshu, D., Kreuter, M.W., & Weaver, N.L. (2008) A glossary for
dissemination and implementation research in health. J Public Health Management Practice, 14(2), 117–123.
Core Elements
Core Elements: required components that represent the logic
mechanisms of change and key delivery steps of an EBA which
most likely produce the EBA’s effectiveness
• Core elements include*:
1) Content
2) Delivery mechanisms
3) Methods
*Eke, A.N., Neumann, M.S., Wilkes, A.L., & Jones, P.L. (2006) Preparing effective behavioral interventions to be used by
prevention providers: the role of researchers during HIV Prevention Research Trials. AIDS Education & Prevention, 18(4
Suppl A):44-58.
Logic Model of Change: Methods used
Methods
Discussion
Objectives
Determinants
Tailoring
Knowledge
Persuasive
Attitude
communication
Modeling
Self-Efficacy
Goal
Behaviors &
Environment
CRC
Screening
Health
Reduce CRC
morbidity &
mortality
Free/low cost tests
Steps for Adaptation
1. Assess fit to consider adaptation
2. Assess the acceptability and importance of adaptation
3. Make final decision of what to adapt
4. Make the adaptation
5. Pretest and pilot test
9
1. Assess
Adaptation Categories
Fit
Your Community
EBA
Fit outcomes;
adaptation ideas
Yes, No, Partially;
Notes
Program Outcomes, Goals and Objectives
Health outcomes/ Goal
Goal:
Outcome:
Behavior objectives
Behavior 1
Sub-behaviors
Behavior 2
Sub-behaviors
Objectives:
Outcomes:
Environmental objectives
Objectives for
actors, facilities:
Outcomes for
actors, facilities:
Determinants & Methods
10
1. Assess
Adaptation Categories
Fit
Your Community
EBA
Fit outcomes;
adaptation ideas
Yes, No, Partially;
Notes
Program Outcomes, Goals and Objectives
Health outcomes/ Goal
Goal:
Outcome:
Determinant 1,
related objective,
method
………………………
Determinant 2,
related objective,
method
Determinant 1
addressed,
methods used
…………………………
Determinant 1
addressed,
methods used
Behavior objectives
Environmental objectives
Determinants & Methods
Determinant 1
Method
…………………………
Determinant 2
Method
11
1. Assess Fit
2. Assess Acceptability and Importance
Assess acceptability
There is a continuum for adaptation
changes:
… should be avoided (red)
To maintain fidelity on core
components
…should be made cautiously
(yellow)
…safe (green)
Adapted from:
Lesesne, C. A., Lewis, K. M., Moore, C., Fisher, D., Green, D., & Wandersman, A. (2007). Promoting Science-based Approaches to Teen Pregnancy
Prevention using Getting To Outcomes: Draft June 2007. Unpublished manual.
Firpo-Triplett, R., Fuller, T. R. (2012). General Adaptation Guidance: A Guide to Adapting Evidence-Based Sexual Health Curricula. Accessed via
http://recapp.etr.org/recapp/documents/programs/GeneralAdaptationGuidanceFINAL.pdf
Red Light Adaptations:
Things That Probably Cannot Be Modified
• Methods used
– Change theoretical underpinning;
mechanisms of change
• Content
– Change health topic/behavior addressed
– Add activities that contradict or detract
from the original EBA’s goals
– Delete whole sections or major activities
– Reduce duration and dose
Yellow Light Adaptations:
Things That Can Probably Be Changed with Caution
• Content/ methods
– Alter the length of program activities
– Change the order of sessions or
sequence of activities
– Add activities to address other
risk factors or behaviors
– Apply EBA to a different population
• Delivery mechanisms
–
–
–
–
Change delivery format/ process
Modify who delivers the program
Change setting of delivery
Substitute activities and/or materials
Green Light Adaptations:
Things That Can Probably Be Modified
Minor adaptations to increase reach,
receptivity and participation
• Update and/or customize statistics and
guidelines
• Customize program materials to fit the
priority population. E.g., change names,
pictures, wording, etc.
• Change ways to recruit and/or engage
priority population
Consult Experts to Assess Importance
• EBA experts
• Content experts
• Community
representatives
• Organization
stakeholders
 Final decision making
Image courtesy of Ambro at FreeDigitalPhotos.net
Consult EBA & Content Experts
EBA Experts
• Discuss core elements
− Evaluated?
− Their beliefs?
− Exchange ideas about
potential adaptation
Content Experts
•
Insight into “core elements” and
need for adaptation
Image courtesy of David Castillo Dominici at
FreeDigitalPhotos.net
Consult Community & Organization Experts
• Discuss fit between CA and EBA with community
experts (include priority population)
̶ How important is adaptation to achieve fit?
To ensure:
• Reach
• Acceptability
• Feasibility
• Effectiveness
• Representatives from organization
̶ Insight into possibilities for implementation
Image courtesy of Ambro at FreeDigitalPhotos.net
Additional Considerations
Consider pros and cons for adaptation
•
Re: Adaptations to fit priority population
Diversity within priority population may be larger than the
diversity of the population addressed by EBA
̶
Stigmatization
̶
Costs, feasibility
•
̶
̶
Re: Adaptations to community and context
Try to think about possibilities for implementation as is
instead of barriers
3. Make final decision of what to adapt
•
Using considerations and stakeholder input,
make a final decision of what to adapt
•
Think through steps for making the adaptation
4. Make the Adaptation
•
Relatively straightforward for “green light
adaptations” to priority population
̶ E.g., Replace graphics, key figures,
pictures, wording
•
A bit more complex for “yellow light adaptations”
−
−
−
Select behavioral and/ or determinant objectives
not yet addressed by EBA
Search for methods to address these determinants
(and related behaviors)
Adaptation of delivery mechanisms
5. Pretesting & Pilot testing
Pretest
•
Trying out program elements (e.g., materials) with
intended end users
−
Adapted elements
−
Non-adapted elements
Pilot test
•
Tryout implementation to assess fit with community
and organization/ coalition
5. Pretesting & Revision
•
Trying out program elements (e.g., materials) with
intended participants (i.e., priority population)
−
−
•
Adapted elements
Non-adapted elements
For example test on:
−
−
−
−
−
Comprehension
Acceptability
Attractiveness
Cultural relevancy
Potential influence on determinants
5 (cont’). Pilot Testing & Implementation
• Is there an implementation protocol?
E.g., manual
̶
If not, needs to be developed
̶
If there is one, adaptation/ addition may be needed
because of adaptations to EBA
-
Who does
- What,
- When,
- Why (motivations, barriers),
- and How
5 (cont’). Pilot Testing & Implementation
Pilot testing
• Tryout implementation to assess fit with community and
organization/ coalition
̶
̶
̶
̶
Adherence to program
protocol
Dose delivered
Quality of program delivery
Barriers/ facilitators
*Rabin, B.A., Brownson, R.C., Haire-Joshu, D., Kreuter, M.W., & Weaver, N.L., (2008). A glossary for
dissemination and implementation research in health. Journal of Public Health Management Practice, 14(2),
pp. 117-123.
Activity: Adaptation Tool for Programs
Activity: Adaptation Tool for Programs
1. Read the program description
individually for StairWELL to Better
Health
2. Discuss adaptation using the
Adaptation Tool in your small group
3. Share what you decided to adapt,
why, and how
Activity: Adaptation Tool Activity
Activity: Adaptation Tool for Policy
1. Read the tobacco-free policy
descriptions individually
2. Discuss adaptation using the
Adaptation Tool in your small group
3. Share what you decided to adapt,
why, and how
Next Step: Evaluation
LOW
FIDELITY
HIGH
FIDELITY
GREATER NEED
FOR EVALUATION
MAJOR
ADAPTATION
MINOR
ADAPTATION
Carvalho, M., Honeycutt, S., Escoffery, C., Glanz, K., Sabbs, D., & Kegler, M. (2013). Balancing fidelity and
adaptation: implementing evidence-based chronic disease prevention programs. Journal of Public
Health Management and Practice, 19(4), 348-356.
Take-home Points: Importance of
Adapting Based on Needs of Community
•
Base changes on your community assessment results
•
Identify the core elements of an EBA and keep them
intact in adaptation
•
Work with your community to get their feedback as you
make changes
•
Get advice from experts including the EBA developers in
making yellow and green light adaptations
•
The more you adapt, the more you need to evaluate
Questions?