title: Balancing fidelity and adaptation: implementing evidence-based chronic disease prevention programs.
abstract: OBJECTIVE
  To describe adaptations that community-based organizations (CBOs) made to evidence-based chronic disease prevention intervention programs and to discuss reasons for those adaptations.
  
  
  METHODS
  The process evaluation used project report forms, interviews, and focus groups to obtain information from organizational staff.
  
  
  METHODS
  Programs were conducted in community-based organizations (n = 12) in rural southwest Georgia including churches, worksites, community coalitions, a senior center, and a clinical patient setting.
  
  
  METHODS
  Site coordinators (n = 15), organizational leaders (n = 7), and project committee members (n = 25) involved in program implementation at 12 funded organizations.
  
  
  METHODS
  The Emory Cancer Prevention and Control Research Network awarded mini grants to rural CBOs to implement one of 5 evidence-based nutrition or physical activity programs. These sites received funding and technical assistance from Emory and agreed to conduct all required elements of the selected evidence-based program.
  
  
  METHODS
  Program implementation and context were explored, including completion of core elements, program adaptation, and reasons for adaptation that occurred at sites implementing evidence-based chronic disease prevention programs.
  
  
  RESULTS
  Five major types of adaptations were observed: changing educational materials, intended audience, and program delivery; adding new activities; and deleting core elements. Sites had intentional or unintentional reasons for making program adaptations including enhancing engagement in the program, reaching specific audiences, increasing program fit, and reinforcing program messages. Reasons for not completing core elements (program deletions) included various types of "turbulence" or competing demands (eg, leadership/staff transitions and time constraints).
  
  
  CONCLUSIONS
  The types of adaptations and reasons described in this evaluation support the idea that adaptation is a natural element of implementing evidence-based interventions. Building this understanding into dissemination strategies may help researchers and funders better reach communities with evidence-based interventions that are a relevant fit, while striving for fidelity.
authors: Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA. mlcarva@emory.edu
authors: Michelle L
authors: ML
authors: Carvalho
authors: Sally
authors: S
authors: Honeycutt
authors: Cam
authors: C
authors: Escoffery
authors: Karen
authors: K
authors: Glanz
authors: Darrell
authors: D
authors: Sabbs
authors: Michelle C
authors: MC
authors: Kegler
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control*; D003153:Community Health Services / Q000458:organization & administration; D055317:Evidence-Based Practice / Q000379:methods / Q000458:organization & administration*; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D016730:Program Development; D015397:Program Evaluation