Challenges in Replicating Interventions

University of Washington Seattle, Seattle, Washington, United States
Journal of Adolescent Health (Impact Factor: 3.61). 07/2007; 40(6):514-20. DOI: 10.1016/j.jadohealth.2006.09.005
Source: PubMed


To describe and reflect on an effort to document, through a set of 6 interventions, the process of adapting effective youth risk behavior interventions for new settings, and to provide insights into how this might best be accomplished.
Six studies were funded by the NIH, starting in 1999. The studies were funded in response to a Request for Applications (RFA) to replicate HIV prevention interventions for youth. Researchers were to select an HIV risk reduction intervention program shown to be effective in one adolescent population and to replicate it in a new community or different adolescent population. This was to be done while systematically documenting those processes and aspects of the intervention hypothesized to be critical to the development of community-based, culturally sensitive programs. The replication was to assess the variations necessary to gain cooperation, implement a locally feasible and meaningful intervention, and evaluate the outcomes in the new setting. The rationale for this initiative and description of the goals and approaches to adaptation of the funded researchers are described.
Issues relevant to all interventions are discussed, in addition to those unique to replication. The processes and the consequences of the adaptations are then discussed. The further challenges in taking a successful intervention "to scale" are not discussed.
Replications of effective interventions face all of the challenges of implementation design, plus additional challenges of balancing fidelity to the original intervention and sensitivity to the needs of new populations.

Download full-text


Available from: Elaine Borawski
  • Source
    • "Adoption is the process of implementing an intervention as it was originally developed; its core elements and key characteristics remain intact. While a number of methods have been described to guide the identification of core elements (Bell et al. 2007; Center for Substance Abuse Prevention 2002; Fixsen et al. 2005; Galbraith et al. 2011; Kelly et al. 2008; McKleroy et al. 2006), we followed Kelly et al.'s (2000) useful approach of using program practice analysis to identify the core elements of FOCUS. We assembled an expert panel consisting of the intervention's original developers and end users to conduct a qualitative assessment of its components , activities, and delivery methods. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In response to the needs of military families confronting the challenges of prolonged war, we developed Families OverComing Under Stress (FOCUS), a multi-session intervention for families facing multiple deployments and combat stress injuries adapted from existing evidence-based family prevention interventions (Lester et al. in Mil Med 176(1): 19-25, 2011). In an implementation of this intervention contracted by the US Navy Bureau of Medicine and Surgery (BUMED), FOCUS teams were deployed to military bases in the United States and the Pacific Rim to deliver a suite of family-centered preventive services based on the FOCUS model (Beardslee et al. in Prev Sci 12(4): 339-348, 2011). Given the number of families affected by wartime service and the changing circumstances they faced in active duty and veteran settings, it rapidly became evident that adaptations of this approach for families in other contexts were needed. We identified the core elements of FOCUS that are essential across all adaptations: (1) Family Psychological Health Check-in; (2) family-specific psychoeducation; (3) family narrative timeline; and (4) family-level resilience skills (e.g., problem solving). In this report, we describe the iterative process of adapting the intervention for different groups of families: wounded, ill, and injured warriors, families with young children, couples, and parents. We also describe the process of adopting this intervention for use in different ecological contexts to serve National Guard, Reserve and veterans, and utilization of technology-enhanced platforms to reach geographically dispersed families. We highlight the lessons learned when faced with the need to rapidly deploy interventions, adapt them to the changing, growing needs of families under real-world circumstances, and conduct rigorous evaluation procedures when long-term, randomized trial designs are not feasible to meet an emergent public health need.
    Full-text · Article · Oct 2013 · Clinical Child and Family Psychology Review
  • Source
    • "Guided by established psychosocial theories such as social cognitive theory [1] and social influence theory [2] [3], these interventions seek to reduce sexual risk-taking behaviors, such as sexual initiation and frequency of sex, first by impacting psychosocial mediating factors, such as attitudes and selfefficacy regarding those behaviors [4] [5] [6]. Researchers in the field recognize a critical need for further examination of psychosocial mediating factors to gain insight into the mechanisms of action influencing behavior change for these interventions [4] [5] [6] because there are little data available on which psychosocial variables provide the actual mediating causal mechanisms through which HIV/STI/pregnancy prevention interventions change sexual risk-taking behaviors for adolescent populations. In this study a set of mediation analyses was carried out using data from It's Your Game. . "
    [Show abstract] [Hide abstract]
    ABSTRACT: A set of mediation analyses were carried out in this study using data from It's Your Game. . .Keep It Real (IYG), a successful HIV/STI/pregnancy prevention program. The IYG study evaluated a skill and normbased. HIV/STI/pregnancy prevention program that was implemented from 2004 to 2007 among 907 urban low-income middle school youth in Houston, TX, USA. Analyses were carried out to investigate the degree to which a set of proposed psychosocial measures of behavioral knowledge, perceived self-efficacy, behavioral, and normative beliefs, and perceived risky situations, all targeted by the intervention, mediated the intervention's effectiveness in reducing initiation of sex. The mediation process was assessed by examining the significance and size of the estimated effects from the mediating pathways. The findings from this study provide evidence that the majority of the psychosocial mediators targeted by the IYG intervention are indeed related to the desired behavior and provide evidence that the conceptual theory underlying the targeted psychosocial mediators in the intervention is appropriate. Two of the psychosocial mediators significantly mediated the intervention effect, knowledge of STI signs and symptoms and refusal self-efficacy. This study suggests that the underlying causal mechanisms of action of these interventions are complex and warrant further analyses.
    Full-text · Article · Jun 2012 · AIDS research and treatment
  • Source
    • "Table 1 integrates health intervention adaptation activities delineated in systematic stage models (Barrera & Castro, 2006; Kumpfer et al., 2008; McKleroy et al., 2006; Wingood & DiClemente, 2008). HIV/AIDS has been the subject of more stage models for the cultural adaptation of interventions than any other health condition (Card, Solomon, & Cunningham, 2011; Dévieux, Malow, Rosenberg, & Dyer, 2004; Dworkin, Pinto, Hunter, Rapkin, & Remien, 2008; Kelly et al., 2000; McKleroy et al., 2006; Solomon, Card, & Malow, 2006; Tortolero et al., 2005; Wainberg et al., 2007; Wingood & DiClemente, 2008), in part because of National Institutes of Health directives that called for such adaptations (Bell et al., 2007). A critical aspect of cultural adaptation stage models is that they integrate " top-down " and " bottom-up " approaches. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research. Method: Influential literature from the past decade was examined to identify points of consensus. Results: There is agreement that cultural adaptation can be organized into 5 stages: information gathering, preliminary design, preliminary testing, refinement, and final trial. With few exceptions, reviews of several health conditions (e.g., AIDS, asthma, diabetes) concluded that culturally enhanced interventions are more effective in improving health outcomes than usual care or other control conditions. Conclusions: Progress has been made in establishing methods for conducting cultural adaptations and providing evidence of their effectiveness. Future research should include evaluations of cultural adaptations developed in stages, tests to determine the effectiveness of cultural adaptations relative to the original versions, and studies that advance our understanding of cultural constructs' contributions to intervention engagement and efficacy. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
    Full-text · Article · Jan 2012 · Journal of Consulting and Clinical Psychology
Show more