UCLA Department of Family Medicine and Center for HIV Identification, Prevention and Treatment Services, Los Angeles, CA, USA.
Implement Sci. 2009 Nov 23;4:76. doi: 10.1186/1748-5908-4-76.
Evidence-based interventions that are being delivered in real-world settings are adapted to enhance the external validity of these interventions. The purpose of this study was to examine multiple intervention adaptations made during pre-implementation, implementation, maintenance, and evolution phases of human immunodeficiency virus HIV prevention technology transfer. We examined two important categories of adaptations -- modifications to key characteristics, such as activities or delivery methods of interventions and reinvention of the interventions including addition and deletion of core elements.
Study participants were thirty-four community-based organization staff who were implementing evidence-based interventions in Los Angeles, California. Participants were interviewed twice and interviews were professionally transcribed. Transcriptions were coded by two coders with good inter-rater reliability (kappa coefficient = 0.73). Sixty-two open-ended codes for adaptation activities, which were linked to 229 transcript segments, were categorized as modifications of key characteristics or reinvention.
Participants described activities considered modifications to key characteristics and reinvention of evidence-based interventions during pre-implementation, implementation, and maintenance phases. None of the participants reported accessing technical assistance or guidance when reinventing their interventions. Staff executed many of the recommended steps for sound adaptation of these interventions for new populations and settings.
Staff reported modifying and reinventing interventions when translating HIV prevention programs into practice. Targeted technical assistance for formative evaluation should be focused on the pre-implementation phase during which frequent modifications occur. Continuous or repeated measurements of fidelity are recommended. Increased technical assistance and guidance are needed to ensure that reinventions are evaluated and consistent with the aims of the original interventions. Providing strategic technical assistance and written guidance can facilitate effective HIV prevention technology transfer of evidence-based interventions.
在真实环境中实施的循证干预措施经过适应性调整，以提高这些干预措施的外部有效性。本研究的目的是检验在人类免疫缺陷病毒（HIV）预防技术转让的实施前、实施和维持以及演变阶段所进行的多项干预措施适应性调整。我们考察了两类重要的调整措施——对干预措施的关键特征（如活动或交付方法）的修改和干预措施的重新设计，包括核心要素的增加和删除。
研究参与者是 34 名在加利福尼亚州洛杉矶实施循证干预措施的社区组织工作人员。参与者接受了两次访谈，访谈内容由专业人员进行转录。两名编码员对转录内容进行了编码，他们的编码一致性较好（kappa 系数=0.73）。共有 62 个用于适应活动的开放性编码，这些编码与 229 个转录片段相关联，分为对关键特征的修改和重新设计。
参与者描述了在实施前、实施和维持阶段，被视为对关键特征的修改和对循证干预措施的重新设计的活动。没有参与者报告在重新设计干预措施时获得技术援助或指导。工作人员在为新的人群和环境对这些干预措施进行适应性调整时，执行了许多推荐步骤。
工作人员报告在将 HIV 预防方案转化为实践时对干预措施进行了修改和重新设计。针对形成性评价的有针对性的技术援助应集中在实施前阶段，该阶段经常需要进行修改。建议进行持续或重复的保真度测量。需要增加技术援助和指导，以确保重新设计得到评估并与原始干预措施的目标保持一致。提供战略性的技术援助和书面指导可以促进循证干预措施的有效 HIV 预防技术转让。
