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Adapting Interventions

Even if an intervention is evidence-based, it may not meet a rural community's particular needs. When looking for the right obesity intervention, it's important to consider audience factors such as:

  • Culture
  • Literacy
  • Learning style
  • Setting of the intervention

It is not always possible to find the right match for all these components. Some model programs may include activities that don’t match the culture of the participants. In these cases, it may be necessary to evaluate the source of the mismatch and what the effect may be. Following that evaluation, an existing model might be adapted to fit the target population.

For a detailed overview of changes and adaptations for rural programs, see Considerations When Adapting a Program in the Rural Community Health Toolkit.

Table 5-1: Sources and Effects of Program Mismatches
Source of Mismatch Actual or Potential Mismatch Effect
Group Characteristics  
  • Language
Participants do not understand program content
  • Ethnicity
Conflicts in belief, values, and/or norms
  • Socioeconomic status
Insufficient social resources and culturally different life experiences
  • Differences between urban and rural communities
Logistical and environmental barriers affecting participation in program activities
Risk Factors  
  • Number and severity
Insufficient effect on multiple or most severe risk factors
Program Delivery Staff  
  • Type of staff
Staff may not have the skills and knowledge to successfully implement the program
  • Staff cultural competence
Limited awareness of, or insensitivity to, cultural issues
Administrative/Community Factors  
  • Community consultation
Absence of community buy-in, community resistance or disinterest, low participation
  • Community readiness
Absence of infrastructure and organization to address problems and implement the program

Source: The Cultural Adaptation of Prevention Interventions: Resolving Tensions between Fidelity and Fit
Castro, F.G., Barrera, M., & Martinez, C.R.; Prevention Science Vol. 5, No. 1, March 2004