Program Fidelity and Adaptation: Meeting Local Needs without Compromising Program Effectiveness, developed by the Cooperative Extension of the University of Wisconsin-Madison, provides guidance for adapting programs while maintaining fidelity.
The National Cancer Institute’s Making the Evidence-Based Program Fit Your Needs: Adaptation and Your Program Summary, part of the Using What Works series, provides details on appropriate program adaptations.
In its Community Tool Box, the University of Kansas provides suggestions for adapting programs to various cultures and communities.
Georgetown University’s National Center for Cultural Competence features self-assessments and resources on cultural competence in healthcare.
Before determining which changes can be made to a given program without endangering fidelity, it is wise to reconsider your selection. Adapting the program could ultimately require more resources than would be required to implement the program as originally designed. How well does the program meet your organizational needs and the needs of your audience? Will it appeal to your audience? Does it target relevant outcomes? If an alternative program that requires little or no adaptation is available, now is the time to consider changing courses and implementing it instead.
It is a good idea to contact the developer of the program to discuss proposed adaptations. The program developer will be able to tell you which adaptations have been made before. He or she will also be able to elaborate on the theories and assumptions that influenced the program’s development. Getting input from the developer is the best way to ensure that any adaptations made to the program are appropriate. The contact information for program developers can be found on databases of EBPs, including those discussed under Identifying Evidence-Based Interventions.
In general, adaptations can be made to two aspects of a program: key elements (or components) and characteristics. Key elements or components are the “active ingredients” of a program—the components that generate the positive outcomes. Characteristics of a program are the appearances and features that distinguish a program. Characteristics can usually be adapted without influencing program outcomes. However, great caution should be exercised when adapting key elements. As noted earlier, the program developers are best suited to make adaptations to key elements. Table 4 provides examples of program adaptations and indicates the degree of caution that must be exercised when making each adaptation. Keep in mind that though characteristics can often be adapted without changing outcomes, you may still need permission from the program developer to make changes in order to adhere to copyright laws.
|Types of Program Adaptations|
|Adaptation||Adapt cautiously||Adapt carefully||Adapt Freely|
|Removing or changing topics||X|
|Replacing or modifying cultural references||X|
|Reducing the number, length, or frequency of sessions||X|
|Changing fonts and font size||X|
|Replacing images to reflect the ethnic and cultural makeup of your audience||X|
|Eliminating key messages or skills training||X|
|Using personnel without adequate training or qualifications||X|
|Modifying language (e.g., translating or changing words to increase readability)||X|
|Reducing the number of materials and resources given to participants||X|
|Adding contact information for your organization and local resources||X|
|Targeting a different audience||X|
|Changing aesthetic elements to make the program more appealing to your audience||X|
|Updating health statistics and other science-based information to reflect current findings||X|
What if your organization has committed to implementing a given program and you realize that fidelity may be threatened because you need to adapt several key elements to make the program suitable for your audience? You are not necessarily trapped; there are a few courses of action to consider. First, get in touch with the program developers. They will be able to provide insight into the impact the adaptations will have on outcomes. Additionally, the developers may be interested in working with you and collecting data to evaluate the impacts of the adaptations on program outcomes, as this would contribute to the program’s evidence base. Second, find additional resources. Adaptations are often necessary because of resource limitations (e.g., limited funding, insufficient staff, inadequate facilities). If this is the case for you, then reevaluate your funding options and your opportunities for partnerships with organizations that have the resources you lack (see Obtaining Funding and Establishing Partnerships for more information). Finally, you can select an alternative program. While this is a difficult choice if you have already invested time and money into a program, it is important to consider the consequences of moving forward with a program that will be implemented without fidelity due to extensive adaptations.