Understanding the Details of Your Evidence-Based Options

Starr BanksCherie Rooks-Peck

Kathi WilsonCommunity Guide Branch,

Centers for Disease Control and Prevention

September 10, 2013Association of Maternal & Child Health Programs

Center for Surveillance, Epidemiology, and Laboratory Services (proposed) Division of Epidemiology, Analysis, and Library Services (proposed)

Disclaimer

Any views or opinions expressed by the speaker do not necessarily represent the views of the CDC, HHS, or any other entity of the United States government. Furthermore, the use of any product names, trade names, images, or commercial sources is for identification purposes only, and does not imply endorsement or government sanction by the U.S. Department of Health and Human Services.

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AcknowledgementsThis training is brought to you by

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Today’s Learner Objectives

Identify factors that influence choice of evidence-based strategies and interventions.

Identify the types of information needed from your community and organization to ensure a proper match with an intervention.

Assess the fit of the organization to the potential strategies and interventions

Identify elements that can and cannot be changed when using an intervention.

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Homework Review: How Did it Go?

Scavenger Hunt Handout1. Explore The Community Guide website and answer questions

specific to the Task Force-recommended strategy, Behavioral and Social Approaches to Increase Physical Activity: Individually-Adapted Health Behavior Change Programs.

2. Use the RTIPs and Center TRT websites to• Select one program intervention from each that is aligned with the Task

Force-recommended strategy, Behavioral and Social Approaches to Increase Physical Activity: Individually-Adapted Health Behavior Change Programs.

• Answer questions for each program intervention you selected.

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Homework Review: How Did it Go? (cont’d)

Intervention Comparison Tool Handout1. Review your responses on the Organizational Readiness Checklist.

2. Consider the information you gathered about your health priority and community.

3. Fill out only the first blank column “Priority Area for Our Community” based on your community as well as your responses for the Organizational Readiness Checklist. You will fill out the remaining columns during our next webinar.

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Community Assessment

Implementation & Evaluation

Establishing Goals &

Objectives;Planning for Evaluation

Finding Evidence

Selection

Adaptation

Where do We Stand?

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Sustainability

SELECTING AN EVIDENCED-BASED OPTION THAT FITS YOUR COMMUNITY

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Why Is Understanding the Details of Evidence-Based Options Important?

Assess how much adaptation is needed by gauging its fit to your community and organization.

Review methods, facilitators’ guide or implementation protocol to understand the steps for delivery.

Learn the costs of implementation.

In short, decide which program to use.

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Before You Hit the Ground Running

Consider the goals, objectives and target audience for your proposed program, practice or policy.

Consider the characteristics of the organization or setting.

Then, select the best one to match those goals, objectives, and audience.

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Definition of Fit

Overall compatibility between a strategy and the– Audience and community

served. – Organization that will implement

it.

Ideal Match

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Fit Considerations

Strategy and Intervention• Health behaviors/topics• Goals• Type of delivery methods• Time span• Settings

Audience• Age• Education• Gender• Race/ethnicity• Socioeconomic status

Organization• Fit with mission• Leadership support• Availability of a project

coordinator• Resources:

• Finances/cost• Staff & expertise• Facilities• Partnerships

Community• Priorities and values• Readiness for prevention• Fit with other programs

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What do you think?

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Activity!

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Activity: Selecting an Intervention

1. Using the RTIPs and Center TRT websites, choose two intervention programs to address your identified priority area (from Column 2).

2. Using the Intervention Comparison Toola. Complete Option 1 & Option 2 Columns using

information you find about each intervention program.b. Compare Option 1 & Option 2 and discuss how each

might fit with your population and organization.

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Intervention Comparison Tool

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Activity: Selecting an Intervention (cont’d)

3. Tell us what you chose and why.Process: We will hear from three groups.

If you would like to volunteer your choices, RAISE YOUR HAND in the webinar. We will randomly select someone. Once someone is selected, please LOWER YOUR HAND.

After the first response, if you have chosen a different intervention and are willing to explain, please RAISE YOUR HAND. We will randomly select someone. Once someone is selected, please LOWER YOUR HAND.

After the second response, if you have chosen a different intervention and are willing to explain, please RAISE YOUR HAND. We will randomly select someone. Once someone is selected, please LOWER YOUR HAND. 17

ADAPTING INTERVENTIONS TO FIT YOUR COMMUNITY

Adopt AdaptAdapt

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Adaptation is……

…making Changes Additions Deletions Substitutions

…to an evidence-based strategy to make it more suitable for a particular population or an organization’s capacity.

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Adaptation Dilemma for Practitioners

During the adaptation process, planners often choose pieces of programs that are the most appealing or that seem the most feasible, usually there is not much input from the community.

Little or no process for determining what in a program needs to change and what must stay the same.

This can lead to programs that are incomplete with little chance of maintaining impact.

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Adaptation Dilemma for Researchers

Some authors suggest that when developmental issues and program targets are appropriate, adaptation is seldom or never needed (Elliot and Mihalic, 2004).

Others point out that the formative work to support adaptation is seldom done (Lau, 2006).

Nevertheless, in practice…Adaptation Happens.

Elliott, D. S. & Mihalic, S. (2004). Issues in disseminating and replicating effective prevention programs. Prevention Science, 5, 47-53Lau, A. (2006). Making the case for selective and directed cultural adaptations of evidence-based treatments. Clinical Psychology: Science and

Practice, 13 (4), 295-310.

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Effective adaptation of a community-based program involves balancing…

Fit:

Increasing compatibility between an evidence-based strategy and the organizational setting and audience characteristics.

Fidelity:

Implementing core elements and key process steps as intended in the original evidence-based strategy.

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Program Fidelity

Adherence to program protocol or implementation guide

Dose or amount of program delivered

Quality of program delivery

Participant reaction and acceptance

*Rabin, Brownson, Haire-Joshu, Kreuter, Weaver. A glossary for dissemination and implementation research in health. Journal of Public Health Management Practice, 2008, 14(2), 117–123.

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Fidelity: Core Elements of Evidence-Based Interventions

*Eke, Neumann, Wilkes, Jones. Preparing effective behavioral interventions to be used by prevention providers: the role of researchers during HIV Prevention Research Trials. AIDS Education & Prevention, 2006, 18(4 Suppl A):44-58.

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Three types of core elements

Content Delivery mechanisms Methods

Core Elements of Evidence-Based Programs

Core Content Elements—relate to WHAT is being delivered or taught

Core Pedagogical Elements—relate to HOW the content is delivered or taught

Core Implementation Elements—relate to the WHEN, WHERE, AND BY WHOM [logistics]

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.

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Green, Yellow, & Red Light Adaptations

Provides guidance on whether a particular adaptation is …

…safe (green).…should be made cautiously (yellow).…should be avoided (red).

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.

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Things That Can Probably Be Modified

Names of health care centers or systems.Pictures of people and places and quotes. Hard-to-read words that affect reading level.Wording to be appropriate to audience.Ways to recruit your audience. Incentives for participation.Timeline (based on adaptation guides). Cultural preferences based on population.

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Modifications That Might Be MadeBUT Proceed with Caution

Substituting activities. Modifying who delivers the program. Changing the order of the curriculum or

steps (sequence). Altering the length of program activities. Varying the primary audience. Changing delivery format or process steps. Adding activities to address other

risk factors or behaviors.

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Things That Cannot Be Modified

The health communication model or theory.

The health topic/behavior. Deleting core elements or whole sections

of the program. Reduction in

Timeline (beyond guidelines). Dosage (e.g., activities, time/session).

Adding activities that detract from the core elements.

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What do you think?

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Homework for Next Webinar (Sep 13)

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Program Adaptation Checklist

Homework for Next Webinar (cont’d)

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Program Sustainability Assessment Tool

Community Assessment

Implementation & Evaluation

Establishing Goals &

Objectives;Planning for Evaluation

Finding Evidence

Selection

Adaptation

Next Webinar….

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Sustainability

Questions & Discussion

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Thank you!

Starr BanksCherie Rooks-Peck

Kathi WilsonCommunity Guide Branch,

Centers for Disease Control and Prevention

Starr Banks smbanks@cdc.gov Cherie Rooks-Peck crookspeck@cdc.gov

Kathi Wilson kwilson@cdc.gov

Center for Surveillance, Epidemiology, and Laboratory Services (proposed)Division of Epidemiology, Analysis, and Library Services (proposed)