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Balancing Fidelity and Adaptation: Implementing Evidence-Based Chronic Disease Prevention Programs

Carvalho, Michelle L. MPH; Honeycutt, Sally MPH; Escoffery, Cam PhD, MPH; Glanz, Karen PhD, MPH; Sabbs, Darrell; Kegler, Michelle C. DrPH, MPH

Journal of Public Health Management and Practice: July/August 2013 - Volume 19 - Issue 4 - p 348–356
doi: 10.1097/PHH.0b013e31826d80eb
Original Articles

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.

The objective of this article is to describe adaptations that community-based organizations made to evidence-based chronic disease prevention intervention programs and to discuss reasons for those adaptations.

Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA (Mss Carvalho and Honeycutt and Drs Escoffery and Kegler); Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, PA (Dr Glanz); and Phoebe Putney Memorial Hospital, Albany, GA (Mr Sabbs).

Correspondence: Michelle L. Carvalho, MPH, CHES, Team Lead – Cancer Prevention & Control Research Network, Emory Prevention Research Center, Emory University Rollins School of Public Health (

The authors declare no conflicts of interest.

This research was supported by Cooperative Agreement Number U48DP000043 and 1U48DP0010909-01-1 from the Centers for Disease Control and Prevention and the National Cancer Institute. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or NCI. The authors thank the members of the Emory Prevention Research Center's Community Advisory Board for their many contributions to this project. They thank the organizations that participated in the “Prevention Programs that Work” mini-grants project.

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.