A mixed-method analysis of implementer perspectives on adaptations to an evidence-based intervention for teen dating violence prevention

Background. Efforts to implement evidence-based interventions (EBIs) are often challenged by tension between program fidelity and desire by those who implement EBIs to adapt them to local context. Planned adaptation approaches attempt to anticipate needed adjustments and identify allowable modifications. Yet implementers still perceive a need to adapt to characteristics of program participants and setting in order to achieve intended outcomes. Notwithstanding the value of fidelity, there exists a need to better understand how reflective implementers assess context and make adjustments. Methods. Data are from 11 sites participating in the Start Strong Initiative, a community-based initiative to promote healthy relationships and prevent teen dating violence among middle-school aged students. All Start Strong sites implemented evidence-based curricula, in addition to other program components. We conducted a web-based survey, in-depth interviews, and an online focus group with site coordinators and those implementing curricula. Results. Implementers offered numerous examples in which curriculum was adjusted [to better achieve intended outcomes, weighing the potential value of adjustments against threats to fidelity. Implementers described rationales, methods and outcomes for adjustments made. Adjustments were made to both content and pedagogy, and responded to concerns about comprehension, relevance, resonance, culture, social maturity, student culture and logistics. They described adjustments as improving the curriculum's fit to their context and improving their ability to achieve intended outcomes. Conclusions. Explicating implementers' assessments of implementation and adjustments can offer valuable perspectives on challenges to EBI fidelity. Results can inform strategies to support implementer-informed adaptation processes that are consistent with EBI goals.