Adaptation of Evidence
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Transcript Adaptation of Evidence
Welcome to the Acción Mutua web-seminar:
Adaptation of Evidence-Based Interventions:
An Overview
Before we begin, a little about our format…
Presentation by seminar speakers (approx. 45 min.)
Followed by question and answer session
(approx. 15 min.)
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Acción Mutua is a capacity building
assistance (CBA) program of AIDS
Project Los Angeles in collaboration
with the César E. Chávez Institute of
San Francisco State University
Funded by the Centers for Disease
Control and Prevention
Adaptation of Evidence-Based
Interventions: An Overview
Rosemary Veniegas, Ph.D.
Associate Director – Intervention Core,
Center for HIV Identification, Prevention and Treatment
Services & Behavioral Social Science Volunteer,
American Psychological Association
Contact information [email protected]
(310) 794-0619 ext. 224.
Overview
National
context
Key Concepts and Terms
The Adaptation Process
Guidance & Lessons Learned
Resources for Capacity Building
Assistance (CBA) and Technical
Assistance (TA)
National Context
Infectious Diseases
Substance Abuse, Mental Health
CDC – DEBIs (Diffusion of Effective Behavioral
Interventions)
NIDA – ATTN (Addiction Technology Transfer
Network)
SAMHSA – NREPP (National Registry of
Evidence-based Programs and Practices)
Health Care/Services
AHRQ – PPIP (Put Prevention Into Practice)
NCI – RTIPS (Research Tested Intervention
Programs)
CDC DEBI Website
www.effectiveinterventions.org
SAMHSA NREPP website
www.modelprograms.samhsa.gov
Key Concepts and Terms
Evidence-based intervention
Adaptation & reinvention
Core elements and key characteristics
Fidelity
Technology transfer and exchange
What is Evidence-Based?
(CDC 2003, 2006, 2007)
Evidence-based interventions (EBIs) have
undergone scientific evaluation and been proven to
be efficacious or effective.
Other characteristics can include:
Theoretically based
Specified core elements
Developed by and for target population
Addresses community needs
Effective in changing behaviors
Sustainable over time
Homegrown interventions can be EBIs too!
Popular Opinion Leader, an EBI
Popular Opinion Leader
(Kelly et al., 1991, 2004)
Core elements
Directed to identifiable target population, welldefined community venues, population size
Use of ethnographic techniques to identify
popular, well-liked, trusted individuals
15% of target population trained as POLs
Teaching POL skills for effective behavior
change communication
Weekly POL meetings to refine skills monitor
conversational outcomes
Goal setting for conversations
Review, discuss, reinforce conversation
outcomes
Use of logos/symbols as conversation starters
Popular Opinion Leader
(Kelly et al., 1991, 2004)
Key characteristics
Elicit involvement of gatekeepers
Identify social networks in target
population
Use key informants to identify opinion
leaders from social networks
Train opinion leaders
Seek agreements to have conversations
Place posters at venues, give POLs logo
items to wear
Recruit successive POLs, train
Hold reunion meetings for POLs
What is Adaptation? (McKleroy et al., 2006)
Modifying
key characteristics, activities,
delivery methods without competing or
contradicting core elements, theory or
internal logic of the intervention
Necessary to ensure relevance in local
settings, with new populations, or
comply with funder
Check with your funder about what they
consider appropriate adaptation
Reinvention (CDC, 2006)
Form
of adaptation
Necessary for new populations/settings
Core elements have been modified (i.e.,
adding or dropping)
CDC recommends
Renaming intervention
Formally evaluating prevention outcomes
Ensuring behavioral outcomes were achieved
What are Core Elements?
(CDC, 2003, 2006)
Critical elements believed to be responsible for
EBIs effectiveness
Required elements that represent the theory and
internal logic of the intervention and most likely
produce the intervention’s main effects
Must be implemented with fidelity to increase
the likelihood that prevention providers will
have program outcomes that are similar to
those in the original research
Cannot be ignored, added to, or changed
What are Key Characteristics?
(CDC 2003, 2006)
Crucial activities and delivery methods for
conducting an intervention
CAN be adapted to meet the needs of target
population and ensure cultural
appropriateness
What is Fidelity? (CDC, 2005)
Part
of quality assurance
Implementing or adapting an intervention
that adheres to the core elements and
internal logic of the intervention
Maintaining the core elements, protocols,
procedures, and content that made the
original intervention effective
Keeping the “signature” of the intervention
(Miller, 2007)
Why does fidelity matter?
(Dusenbury et al., 2003)
Adherence
Was intervention delivered as planned?
Dose
What sessions of the intervention were
dropped? Shortened? Added?
Quality of delivery
How skilled were facilitators in
conducting intervention activities?
Participant responsiveness
How did consumers respond to
the intervention?
Why Adapt & Implement EBIs?
EBIs
not yet developed for target population
(e.g., transgenders)
Content may be outdated (e.g., “HIV virus”,
videos need to be updated)
New risk factors or behaviors are identified
(e.g., crystal/methamphetamine)
New intervention policies apply (e.g.,
Advancing HIV Prevention, Prevention with
HIV positive people)
Adaptation and Reinvention
Adaptation
POL for Latino young migrant men (Somerville et
al. 2006)
• Expanded POL training on HIV and STDs
• Communication style module changed to be more
culturally appropriate, non-linear
• Inclusion of referral making in conversations
Reinvention
May be necessary because of new target
population or setting
POL delivered without additional POL training
or monitoring of conversations (Kelly, 2004)
Technology Transfer & Exchange
Transfer
(CDC to CBOs)
Translation, dissemination, acquisition of
information about interventions
(Kraft et al., 2000)
Exchange
(CBOs to CDC, researchers,
community planning groups)
Communication of barriers/facilitators
experienced in practice, to improve
intervention effectiveness (Gandelman et al., 2005)
Transfer
and exchange are necessary to
adaptation
Overview
Assess
Target population
Interventions
Goodness of fit
Stakeholders
Organizational capacity
Decide to adopt, adapt, or
select another intervention
Make necessary changes to
EBI
Select
Prepare
Prepare agency
Pre-test materials
Implementation plan
Successful pilot of adapted
intervention
Implement adapted EBI
Pilot
Implement
(Adapted from McKleroy et al., 2006)
Step 1: Assess
Target
population
Identify target population
Understand risk factors, behavioral
determinants, risk behaviors,
epidemiological trends, social norms
Choose risk factors to target
Identify where, when, how to reach target
population
Step 1: Assess (cont’d)
Interventions
Identify and review possible EBIs
Review content of EBIs
Identify risk factors, behavioral
determinants and risk behaviors
Identify core elements and key
characteristics
Access cost and resources needed
Talk with other agencies
Step 1: Assess (cont’d)
Goodness
of fit
Match between risk factors, behavioral
determinants, and risk behaviors in EBI
and those of target population
Short list of EBIs
Identify areas needed for EBI adaptation
Identify areas for agency capacity building
Step 1: Assess (cont’d)
Stakeholders
Identify stakeholders
Seek input
Assess referral and collaboration
possibilities
Define accountability
Identify competing programs
Phase 1: Assessment (cont’d)
Organizational
capacity
Resources or experience
Physical
Financial
Access
Values/mission
Staff/human resources
Cultural competence
EBI
Evaluation
Accountability
Step 2: Select
Decide
to adopt, adapt, or select another
intervention
Build capacity on EBI and for
implementation
Consult with stakeholders
Consult with staff
Step 2: Select
Make
necessary changes to EBI
(adaptation)
Decide what changes are needed
Seek guidance or technical assistance
Develop timeline and logic model
• A logic model describes the relationships
among risk factors/determinants, intervention
activities and desired outcomes
Track changes made
POL Logic Model
Risk determinants
Intervention Activities
Outcomes
Knowledge of
effective
communication
Teach POLs the
intervention
rationale
perception of
behavior norms
Attitudes/norms
for engaging in
conversations
Teach POLs
conversation
elements
confidence to be
able to engage in
behavior
Self-efficacy to
engage in
conversations
POLs practice and
engage in
conversations
risk behavior in
target community
Adapted from CDC POL Logic Model
Step 3: Prepare
Prepare organization
Recruit/train staff and volunteers
Assign responsibilities
Handle logistics
Confirm referrals and collaborations
Pre-test adapted EBI
With stakeholders
With members of target population
Step 4 : Pilot
Plan for implementing EBI
Agency policies for adapted EBI
Referral networks
Roles and responsibilities
Timeline
Step 4 : Pilot
Gauge success of pilot
Success: move to next step
Failure: review, revise, re-pilot
Fidelity
Adherence
Dose
Quality
Participant response
Step 5 : Implement
Implement adapted EBI
Collect process data
Conduct process monitoring and
evaluation
Collect intervention outcome data
Make small changes based on process
evaluation
Use available technical assistance
Guidance & Guidelines
CDC-specific information on EBIs
Provisional Procedural Guidance for
Community-Based Organizations – Revised
April 2006
CDC Letter to CBOs June 2006
AIDS Education and Prevention Supplement
August 2006 (journal)
Guidance & Guidelines
Other EBIs-related information
Research Tested Intervention Programs (RTIPS) available at
http://rtips.cancer.gov/rtips/index.do
Substance Abuse and Mental Health Services Administration
(SAMHSA) National Registry of Evidence-based Programs
and Practices (NREPP) available at
http://modelprograms.samhsa.gov/template.cfm?page=nrep
pover
Cochrane Health Promotion and Public Health Field review
and protocols available at
http://www.cochrane.org/reviews/en/
The Guide to Clinical Preventive Services available at
http://www.ahrq.gov/clinic/uspstfix.htm
National Guideline Clearinghouse available at
www.guideline.gov/
Center for Information Dissemination and Education
Resources (CIDER) available at
http://www.cider.research.va.gov/products.cfm
Resources for CBA & TA
Centers
for Disease Control and Prevention
Community Planning Groups
Health Departments
Behavioral & Social Science Volunteer
Program
STD/HIV Prevention Training Centers
HIV Prevention Research Centers
CDC
http://0-www.cdc.gov.mill1.sjlibrary.org/hiv/topics/cba/cba.htm
Community Planning Groups
CDC guidance www.cdc.gov/hiv/pubs/hiv-cp.htm
Community Planning Groups
List of CPGs
http://hivinsite.ucsf.edu/InSite?page=li-07-12
Health Departments/UCHAPS
http://www.aidsaction.org/uchaps/
BSSV Website
http://www.apa.org/pi/aids/bssv.html
STD/HIV Prevention Training
Centers
http://depts.washington.edu/nnptc/
HIV Prevention Research Centers
Columbia University HIV Center for Clinical and Behavioral
Studies
www.hivcenternyc.org
Yale University Center for Interdisciplinary Research on AIDS
http://cira.med.yale.edu
Medical College of Wisconsin Center for AIDS Intervention
Research
www.mcw.edu
UCLA Center for HIV Identification, Prevention and Treatment
Services
http://chipts.ucla.edu/
UCSD HIV Neurobehavioral Research Center
http://www.hnrc.ucsd.edu/
UCSF Center for AIDS Prevention Studies
http://www.caps.ucsf.edu/
Thanks go to
Acción Mutua
George Ayala, Psy.D. APLA, GMHC
BSSV/APA
Uyen Kao, MPH
AJ King, MPH, CA STD/HIV Prevention Training Center
For more information or to learn how to receive CBA services,
contact us at: 213.201.1312
[email protected]