Original article
Challenges in Replicating Interventions

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Abstract

Purpose

To describe and reflect on an effort to document, through a set of 6 interventions, the process of adapting effective youth risk behavior interventions for new settings, and to provide insights into how this might best be accomplished.

Methods

Six studies were funded by the NIH, starting in 1999. The studies were funded in response to a Request for Applications (RFA) to replicate HIV prevention interventions for youth. Researchers were to select an HIV risk reduction intervention program shown to be effective in one adolescent population and to replicate it in a new community or different adolescent population. This was to be done while systematically documenting those processes and aspects of the intervention hypothesized to be critical to the development of community-based, culturally sensitive programs. The replication was to assess the variations necessary to gain cooperation, implement a locally feasible and meaningful intervention, and evaluate the outcomes in the new setting. The rationale for this initiative and description of the goals and approaches to adaptation of the funded researchers are described.

Results

Issues relevant to all interventions are discussed, in addition to those unique to replication. The processes and the consequences of the adaptations are then discussed. The further challenges in taking a successful intervention “to scale” are not discussed.

Conclusions

Replications of effective interventions face all of the challenges of implementation design, plus additional challenges of balancing fidelity to the original intervention and sensitivity to the needs of new populations.

Section snippets

The Replication Projects

The 6 studies selected by NIH peer review for funding all provided evidence in their applications of community acceptance and willingness to cooperate in the intervention selected by the principal investigator. Each study took a unique approach to the problems inherent in adaptation. Table 1 provides a quick reference point, and thumbnail sketches of the 6 projects follow:

Borawski replicated Jemmott’s Be Proud! Be Responsible! (BPBR) among older adolescents in 5 urban and suburban high schools

General Issues in Program Implementation

Although this group of studies was initiated to address challenges relevant to program adaptation, each had also to address the common concerns of intervention programs. These issues have been extensively discussed (see specifically, References 6 and 10, and the papers from each investigator about their programs). The issues varied across locations. Briefly, the components are: community support, program fidelity, and staff selection and training.

A variety of different tools were used to

Challenges in the Adaptation Process

There are excellent articles on the technology transfer processes necessary to get a proven product into the field. See the special issue of the Journal of AIDS Education and Prevention in 2000 [volume 12, supplement A]. However, those studies looked for “fit” between the original program and the new venue, rather than changing the intervention to match the community. One [6] did call for a careful examination of the “core elements” of a program when replicating it, although the author did not

Conclusions

Many elements must come together for a prevention program to be replicated and to produce behavior change in a different environment. In replicating their programs, investigators encountered both structural and cultural challenges. Some changes made to the original programs were theory-driven, to bring the examples closer to home, such as in vignettes selecting names of youth from the local community or making references to single- as well as 2-parent families. Some changes were driven by local

Acknowledgments

The 6 principal investigators in this study were awarded funding through an NIH-issued Request for Applications. Stephanie Bell was a Presidential Management Scholar at NICHD when the paper was initiated. The studies upon which this paper is based were funded by 2 NIH institutes, NICHD and NIMH, through the following grants: R01-HD038456 (Borawski), R01-HD039109 (Jemmott), R01-HD038420 (Morrison), R01-MH061761 (Stanton), R01-HD038457 (Tortolero), and R01-MH061187 (Zimmerman).

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