The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit
Abstract
A dynamic tension has developed in prevention science regarding two imperatives: (a) fidelity of implementation-the delivery of a manualized prevention intervention program as prescribed by the program developer, and (b) program adaptation-the modification of program 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 between 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.
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Modifications that remove key elements of an intervention, or fail to align with population needs, may be less effective.
“However, modifications that remove key elements of an intervention, or fail to align with population needs, may be less effective [7, 11–14].”
From The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions (2019) · cites this paper as [12]
Fidelity can be a challenge when interventions are implemented in different populations, contexts, and circumstances.
“Fidelity can be a challenge when interventions are implemented in different populations, contexts, and circumstances (7, 22).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [22]
Some adaptations are not deviations from the original effective components of the program and may be beneficial.
“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).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [22]
There has been debate about how to measure the core components of a program, particularly when applied to varied contexts and populations.
“As the discussion of fidelity and adaptation above suggests, there has also been debate about how to measure the core components of a program, particularly when applied to varied contexts and populations (22).”
From The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care (2018) · cites this paper as [22]
Discussions of adaptation to fit an EBI for a particular cultural group most commonly pertain to cultural adaptations.
“Discussions of this issue most commonly pertain to adaptations to fit an EBI for a particular cultural group [58].”
From “Scaling-out” evidence-based interventions to new populations or new health care delivery systems (2017) · cites this paper as [58]
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References 16 · Cited by 1,228
- Authors
- Castro, F. G., Barrera, M., & Martinez, C. R.
- Affiliations
- Arizona State University (US)
- Corresponding author
- Castro, Felipe González
- Venue
- Prevention Science
- Published
- 2004-03
- Volume
- 5
- Issue
- 1
- Pages
- 41-45
- ISSN
- 1389-4986 (ISSN-L)
- 1573-6695
- OpenAlex
- W2126482346
- Cited by
- 1,228
- References
- 16
- Citations by year
- 2026: 48 · 2025: 49 · 2024: 66 · 2023: 59 · 2022: 53 · 2021: 78 · 2020: 122 · 2019: 78 · 2018: 70 · 2017: 59 · 2016: 66 · 2015: 60 · 2014: 69 · 2013: 62 · 2012: 62
- FWCI
- 44.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Prevention Science (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Community Health and Development
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- cultural adaptation, prevention interventions, fidelity, program fit, community-based participatory research, community participation, program design, implementation strategies, manualized intervention
- MeSH terms
- Adolescent, Cultural Characteristics, Humans, Preventive Health Services, Research Design, United States, Program Evaluation, Program Development, Guidelines as Topic
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