Balancing Fidelity and Adaptation: Implementing Evidence-Based Chronic Disease Prevention Programs
Abstract
OBJECTIVES: To describe adaptations that community-based organizations (CBOs) made to evidence-based chronic disease prevention intervention programs and to discuss reasons for those adaptations. DESIGN: The process evaluation used project report forms, interviews, and focus groups to obtain information from organizational staff. SETTING: Programs were conducted in community-based organizations (n = 12) in rural southwest Georgia including churches, worksites, community coalitions, a senior center, and a clinical patient setting. PARTICIPANTS: Site coordinators (n = 15), organizational leaders (n = 7), and project committee members (n = 25) involved in program implementation at 12 funded organizations. INTERVENTION: The Emory Cancer Prevention and Control Research Network awarded mini grants to rural CBOs to implement one of 5 evidence-based nutrition or physical activity programs. These sites received funding and technical assistance from Emory and agreed to conduct all required elements of the selected evidence-based program. MAIN OUTCOME MEASURES: Program implementation and context were explored, including completion of core elements, program adaptation, and reasons for adaptation that occurred at sites implementing evidence-based chronic disease prevention programs. RESULTS: Five major types of adaptations were observed: changing educational materials, intended audience, and program delivery; adding new activities; and deleting core elements. Sites had intentional or unintentional reasons for making program adaptations including enhancing engagement in the program, reaching specific audiences, increasing program fit, and reinforcing program messages. Reasons for not completing core elements (program deletions) included various types of "turbulence" or competing demands (eg, leadership/staff transitions and time constraints). CONCLUSIONS: The types of adaptations and reasons described in this evaluation support the idea that adaptation is a natural element of implementing evidence-based interventions. Building this understanding into dissemination strategies may help researchers and funders better reach communities with evidence-based interventions that are a relevant fit, while striving for fidelity.
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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 [21]
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The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care
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A scoping study of frameworks for adapting public health evidence-based interventions
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Self-citation
- Authors
- Carvalho, M. L., Honeycutt, S., Escoffery, C., Glanz, K., Sabbs, D., & Kegler, M. C.
- Affiliations
- Emory University (US)
- Corresponding author
- Carvalho, Michelle L.
- Venue
- Journal of Public Health Management and Practice
- Published
- 2013-07
- Volume
- 19
- Issue
- 4
- Pages
- 348-356
- ISSN
- 1078-4659 (ISSN-L)
- OpenAlex
- W2041172628
- Cited by
- 110
- References
- 27
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 11 · 2023: 8 · 2022: 14 · 2021: 17 · 2020: 11 · 2019: 7 · 2018: 9 · 2017: 5 · 2016: 6 · 2015: 6 · 2014: 3 · 2013: 3
- FWCI
- 10.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Public Health Management and Practice (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (R01CA163526)
- National Center for Chronic Disease Prevention and Health Promotion (U48DP 000043, 1U48DP0010909-01-1)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Health Sciences › Health Professions › General Health Professions › Community Health and Development
- Keywords
- program adaptation, fidelity, evidence-based interventions, chronic disease prevention, community organizations, rural health, nutrition programs, physical activity programs, cancer prevention, implementation, dissemination, organizational context
- MeSH terms
- Chronic Disease, Community Health Services, Humans, Interviews as Topic, Program Evaluation, Program Development, Focus Groups, Evidence-Based Practice
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