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Considerations When Adapting a Program

It is important to find a balance between implementing a program as it was designed and ensuring that the program components are relevant to the population of interest. One strategy for ensuring your program meets the needs of your community is to involve community members in program planning conversations. Members of the community may include the population of interest, local agencies, and other key players.

An existing model may be adapted to ensure its relevance to your community; however, it is important to avoid removing elements of the program that are responsible for positive results. To avoid mismatching the program and intervention activities with the needs of the community, researchers have suggested that communities consider the following types of proposed program changes and adaptations:

  • Cultural adaptations: Tailoring the intervention to meet community’s worldview and lifestyle
  • Cognitive adaptation: Changing the language, reading, or age level of the intervention
  • Affective-motivational adaptation: Adjusting aspects related to gender, ethnic, religious, and socioeconomic background of participants
  • Environmental adaptation: Ecological aspects of the community, for example implementing in homes instead of at a clinic
  • Adaptations of program content: Tailoring of language, visuals, examples, scenarios, and activities used during the intervention
  • Adaptations of program form: Altering program structure and goals, which have a potential to reduce program effectiveness

Depending on the program being adapted, each of these adaptations could potentially be made without threatening program fidelity. Program fidelity refers to the extent to which the delivery of the program adheres to the program that was originally developed. Program implementers should carefully consider how much they are adapting a program so that effective practices from the original program remain intact. Because of the tension between program fidelity and adaptation, these different adaptations should be carefully selected.

Acceptable changes: Making these changes will not alter the theory and internal logic of the intervention and ensure critical steps contributing to the intervention effectiveness are maintained. Acceptable changes include:

  • Translating language or modifying vocabulary
  • Replacing cultural references
  • Modifying some aspects of activities
  • Adding relevant evidence-based content to make the program more appealing

Less acceptable changes: These changes may make a substantial change to a program's potential effectiveness:

  • Reducing number or length of program sessions
  • Reducing participant engagement
  • Eliminating key messages or skills learned
  • Using inadequately trained staff
  • Using fewer staff members than recommended

The Society for Public Health Education (SOPHE) has also highlighted elements of interventions that can and cannot be modified when dealing with program fidelity:

Aspects that can be modified:

  • Names
  • Pictures/testimonials
  • Wording
  • Location
  • Incentives
  • Timeline

Aspects that should not be modified:

  • Key components
  • Theoretical foundation (e.g. behavior change theory)

Resources to Learn More

The Community Tool Box: Chapter 19 – Section 4. Adapting Community Interventions for Different Cultures and Communities
Addresses different aspects of adapting programs to meet the needs and interests of the intended population.
Organization(s): University of Kansas Work Group for Community Health and Development

Making Adaptations Tip Sheet
This sheet functions as a guide for program implementers to follow when making adaptations to their program. It provides information on how to decide what adaptations are appropriate without negatively impacting the program outcomes.
Organization(s): Administration for Children and Families
Date: 2011

How to Adapt Effective Programs for Use in New Contexts
This article breaks down seven steps to adapt an effective program to a specific community's needs without losing the original, effective program’s impact.
Author(s): Card, J., Solomon, J., & Cunningham, S.
Citation: Health Promotion Practice, 12(1), 25-35
Date: 2011

Taking a Broad Approach to Public Health Program Adaptation: Adapting a Family-based Diabetes Education Program
This article describes the adaptation of a diabetes program to meet the needs of Hispanic populations. The article highlights questions and concerns that practitioners and stakeholders should consider when adapting their own programs.
Author(s): Reinschmidt K., Teufel-Shone, N., Drummond, R.,
Citation: The Journal of Primary Prevention, 31(1-2), 69-83
Date: 2010