11a. Matching Evidence-Based Interventions to Community Conditions: Some Key Considerations  

This week’s module focuses on the adaptation of evidence-based population health interventions to better address key features of the communities they are designed to help.

It is important to find a balance between implementing a population health program or policy as it was designed and ensuring that the program components are relevant to the social, economic, demographic, and cultural realities of a community. One proven strategy for ensuring your program matches community needs is to actively involve community members in intervention planning. Please refer back to Module 6: Community Mobilization for an overview of strategies to achieve this objective.

While existing population health interventions may be adapted to ensure relevance to community needs, it is important to avoid the inadvertent removal of key intervention mechanisms that may be responsible for positive results. To avoid this scenario, researchers have suggested that intervention planners consider the following types of proposed program changes and adaptations.¹

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  Cultural adaptations: Tailoring the intervention to better reflect prevailing community opinions/attitudes (e.g., addressing the role of hunting and fishing in a food security program for an Indigenous community in Northern Canada);
• Cognitive adaptation: Changing the language, reading, or age level of the intervention;
• Affective-motivational adaptation: Adjusting aspects of the intervention related to gender, ethnic, religious, and socioeconomic background of participants;
• Environmental adaptation: Changing the intervention to reflect ecological aspects of the community (e.g., offering smoking cessation support services through a mobile outreach van instead of a centrally located clinic in a rural, geographically dispersed community);
• Adaptations of program content: Tailoring of language, visuals, examples, scenarios, and activities used as part of the intervention;
• Adaptations of program form: Altering program structure and goals, which have a potential to reduce program effectiveness, in response to baseline information about the prevalence of a health problem in a community (e.g., placing greater emphasis on harm reduction goals/objectives in a community with high levels of opioid use).

Each of the above changes can be made without compromising the fidelity of a population health intervention. Fidelity is the extent to which delivery of an intervention adheres to the protocol or program model originally developed.² When implementing a population health intervention, it is important to carefully consider how the intervention is being modified to ensure that effective components of the intervention remain intact.

The following table, adapted from the Rural Health Information Hub at the University of North Dakota,³ summarizes the changes to programs that can and cannot be made without threatening the fidelity of an intervention.

Table 1:  Program Modifications and Desired Intervention Impacts (adapted from the Rural Health Information Hub, School of Medicine and Health Sciences, University of North Dakota)³