Adapting Evidence-Based Interventions for Anxiety for Use in Integrated Primary Care Settings
Adapting an Evidence-based Approach to Fit Your Community.
-
Upload
oliver-dickerson -
Category
Documents
-
view
231 -
download
3
Transcript of Adapting an Evidence-based Approach to Fit Your Community.
![Page 1: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/1.jpg)
Adapting an Evidence-based Approach
to Fit Your Community
![Page 2: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/2.jpg)
Assessing your Community
Implementing & Evaluating
Establishing Goals &
Objectives;Planning for Evaluation
Finding Evidence
Selecting Best Fitting EBAs
Adapting
Where do We Stand?
![Page 3: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/3.jpg)
Session Objectives
• Define adaptation, fidelity, and core elements
• Describe the process and steps for adaptation
• Discuss which changes can probably be made without affecting the effectiveness vs. which cannot
![Page 4: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/4.jpg)
Adaptation
Adaptation: making changes or modifications to fit priority population and local conditions
• Additions
• Deletions
• Substitutions
![Page 5: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/5.jpg)
Fit and Fidelity
Adaptation is a balance between:
Achieving FIT – Make an EBA compatible with your community
Maintaining FIDELITY – Optimize implementation of an EBA as it is prescribed in the original protocol.*
*Rabin, B.A., Brownson, R.C., Haire-Joshu, D., Kreuter, M.W., & Weaver, N.L. (2008) A glossary for dissemination and implementation research in health. J Public Health Management Practice, 14(2), 117–123.
![Page 6: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/6.jpg)
Core Elements
Core Elements: required components that represent the logic mechanisms of change and key delivery steps of an EBA which most likely produce the EBA’s effectiveness
• Core elements include*:
1) Content
2) Delivery mechanisms
3) Methods
*Eke, A.N., Neumann, M.S., Wilkes, A.L., & Jones, P.L. (2006) Preparing effective behavioral interventions to be used by prevention providers: the role of researchers during HIV Prevention Research Trials. AIDS Education & Prevention, 18(4 Suppl A):44-58.
![Page 7: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/7.jpg)
Logic Model of Change: Methods used
Objectives Goal
Reduce CRC morbidity &
mortality
CRC Screening
Free/low cost tests
Determinants
Knowledge
Attitude
Behaviors & Environment
HealthDiscussion
Tailoring
Persuasive communication
Methods
Self-EfficacyModeling
![Page 8: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/8.jpg)
1. Assess fit to consider adaptation
2. Assess the acceptability and importance of adaptation
3. Make final decision of what to adapt
4. Make the adaptation
5. Pretest and pilot test
Steps for Adaptation
![Page 9: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/9.jpg)
9
![Page 10: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/10.jpg)
1. Assess Fit
10
Adaptation Categories Your Community EBA Fit outcomes; adaptation ideasYes, No, Partially;
NotesProgram Outcomes, Goals and Objectives
Health outcomes/ Goal Goal: Outcome:
Behavior objectivesBehavior 1 Sub-behaviorsBehavior 2 Sub-behaviors
Objectives: Outcomes:
Environmental objectives Objectives for actors, facilities:
Outcomes for actors, facilities:
Determinants & Methods
![Page 11: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/11.jpg)
1. Assess Fit
11
Adaptation Categories Your Community EBA Fit outcomes; adaptation ideas
Yes, No, Partially; Notes
Program Outcomes, Goals and Objectives
Health outcomes/ Goal Goal: Outcome:
Behavior objectives
Environmental objectives
Determinants & Methods
Determinant 1 Method…………………………Determinant 2 Method
Determinant 1, related objective, method………………………Determinant 2, related objective, method
Determinant 1 addressed, methods used…………………………Determinant 1 addressed, methods used
![Page 12: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/12.jpg)
1. Assess Fit
![Page 13: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/13.jpg)
2. Assess Acceptability and Importance
![Page 14: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/14.jpg)
Assess acceptability
There is a continuum for adaptation changes:
… should be avoided (red)
To maintain fidelity on core components
…should be made cautiously (yellow)
…safe (green)
Adapted from: Lesesne, C. A., Lewis, K. M., Moore, C., Fisher, D., Green, D., & Wandersman, A. (2007). Promoting Science-based Approaches to Teen Pregnancy Prevention using Getting To Outcomes: Draft June 2007. Unpublished manual.Firpo-Triplett, R., Fuller, T. R. (2012). General Adaptation Guidance: A Guide to Adapting Evidence-Based Sexual Health Curricula. Accessed via http://recapp.etr.org/recapp/documents/programs/GeneralAdaptationGuidanceFINAL.pdf
![Page 15: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/15.jpg)
Red Light Adaptations: Things That Probably Cannot Be
Modified• Methods used
– Change theoretical underpinning;
mechanisms of change
• Content
– Change health topic/behavior addressed
– Add activities that contradict or detract
from the original EBA’s goals
– Delete whole sections or major activities
– Reduce duration and dose
![Page 16: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/16.jpg)
Yellow Light Adaptations: Things That Can Probably Be Changed with
Caution• Content/ methods
– Alter the length of program activities
– Change the order of sessions or
sequence of activities
– Add activities to address other
risk factors or behaviors
– Apply EBA to a different population
• Delivery mechanisms– Change delivery format/ process
– Modify who delivers the program
– Change setting of delivery
– Substitute activities and/or materials
![Page 17: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/17.jpg)
Green Light Adaptations: Things That Can Probably Be Modified
Minor adaptations to increase reach, receptivity and participation
• Update and/or customize statistics and guidelines
• Customize program materials to fit the priority population. E.g., change names, pictures, wording, etc.
• Change ways to recruit and/or engage priority population
![Page 18: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/18.jpg)
Consult Experts to Assess Importance
• EBA experts
• Content experts
• Community representatives
• Organization stakeholders
Final decision making
Image courtesy of Ambro at FreeDigitalPhotos.net
![Page 19: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/19.jpg)
Consult EBA & Content Experts
EBA Experts• Discuss core elements
− Evaluated?− Their beliefs?− Exchange ideas about
potential adaptation
Content Experts• Insight into “core elements” and
need for adaptationImage courtesy of David Castillo Dominici at FreeDigitalPhotos.net
![Page 20: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/20.jpg)
Consult Community & Organization Experts• Discuss fit between CA and EBA with community
experts (include priority population)/ How important is adaptation to achieve fit?
To ensure:• Reach• Acceptability• Feasibility• Effectiveness
• Representatives from organization/ Insight into possibilities for implementation
Image courtesy of Ambro at FreeDigitalPhotos.net
![Page 21: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/21.jpg)
Additional Considerations
Consider pros and cons for adaptation• Re: Adaptations to fit priority population
T Diversity within priority population may be larger than the diversity of the population addressed by EBA
T Stigmatization
T Costs, feasibility
• Re: Adaptations to community and contextT Try to think about possibilities for implementation as is
instead of barriers
![Page 22: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/22.jpg)
3. Make final decision of what to adapt
• Using considerations and stakeholder input, make a final decision of what to adapt
• Think through steps for making the adaptation
![Page 23: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/23.jpg)
4. Make the Adaptation
• Relatively straightforward for “green light adaptations” to priority populationT E.g., Replace graphics, key figures,
pictures, wording
• A bit more complex for “yellow light adaptations” − Select behavioral and/ or determinant objectives
not yet addressed by EBA− Search for methods to address these determinants
(and related behaviors) − Adaptation of delivery mechanisms
![Page 24: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/24.jpg)
5. Pretesting & Pilot testing
Pretest
• Trying out program elements (e.g., materials) with intended end users− Adapted elements− Non-adapted elements
Pilot test
• Tryout implementation to assess fit with community and organization/ coalition
![Page 25: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/25.jpg)
5. Pretesting & Revision
• Trying out program elements (e.g., materials) with intended participants (i.e., priority population)− Adapted elements− Non-adapted elements
• For example test on:− Comprehension− Acceptability− Attractiveness− Cultural relevancy− Potential influence on determinants
![Page 26: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/26.jpg)
5 (cont’). Pilot Testing & Implementation
• Is there an implementation protocol?E.g., manual
/ If not, needs to be developed/ If there is one, adaptation/ addition may be needed
because of adaptations to EBA- Who does
- What, - When,
- Why (motivations, barriers),- and How
![Page 27: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/27.jpg)
5 (cont’). Pilot Testing & Implementation
Pilot testing
• Tryout implementation to assess fit with community and
organization/ coalitionT Adherence to program
protocolT Dose deliveredT Quality of program deliveryT Barriers/ facilitators
*Rabin, B.A., Brownson, R.C., Haire-Joshu, D., Kreuter, M.W., & Weaver, N.L., (2008). A glossary for dissemination and implementation research in health. Journal of Public Health Management Practice, 14(2), pp. 117-123.
![Page 28: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/28.jpg)
Activity: Adaptation Tool for Programs
![Page 29: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/29.jpg)
Activity: Adaptation Tool for Programs
1. Read the program description individually for StairWELL to Better Health
2. Discuss adaptation using the Adaptation Tool in your small group
3. Share what you decided to adapt, why, and how
![Page 30: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/30.jpg)
Activity: Adaptation Tool Activity
![Page 31: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/31.jpg)
Activity: Adaptation Tool for Policy
1. Read the tobacco-free policy descriptions individually
2. Discuss adaptation using the Adaptation Tool in your small group
3. Share what you decided to adapt, why, and how
![Page 32: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/32.jpg)
Next Step: Evaluation
HIGHFIDELITY
LOWFIDELITY
MINOR
ADAPTATIONMAJOR
ADAPTATION
GREATER NEEDFOR EVALUATION
Carvalho, M., Honeycutt, S., Escoffery, C., Glanz, K., Sabbs, D., & Kegler, M. (2013). Balancing fidelity and adaptation: implementing evidence-based chronic disease prevention programs. Journal of Public Health Management and Practice, 19(4), 348-356.
![Page 33: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/33.jpg)
Take-home Points: Importance of Adapting Based on Needs of Community
• Base changes on your community assessment results
• Identify the core elements of an EBA and keep them intact in adaptation
• Work with your community to get their feedback as you make changes
• Get advice from experts including the EBA developers in making yellow and green light adaptations
• The more you adapt, the more you need to evaluate
![Page 34: Adapting an Evidence-based Approach to Fit Your Community.](https://reader038.fdocuments.in/reader038/viewer/2022102908/56649e1a5503460f94b07fec/html5/thumbnails/34.jpg)
Questions?