Expanding the Cultural Adaptation Framework for Population-Level Impact.

Attention to cultural diversity and cultural adaptation of evidence-based interventions (EBIs) has been a longstanding priority in prevention science. However, EBIs for diverse populations present several challenges for broad dissemination and population impact. The five papers in this special issue underscore some of these challenges and offer new ways of thinking and recommendations for the next generation of type 2 translation research. This commentary underscores three broad recommendations, including the need for a more expanded conceptualization and empirical understanding of the core tension between fidelity and adaptation; greater focus on the systems of care that deliver EBIs to culturally diverse populations, including increased attention to such issues as access and engagement; and greater flexibility in strategies to adapt and evaluate interventions within and across communities and settings that serve diverse populations. By offering exemplars and suggestions to address these challenges, these papers collectively help to realign research on cultural adaptation with its ultimate goal of reducing health disparities by ensuring greater access, impact, and equity of prevention services in a dynamic, multicultural society. However, other fundamental challenges remain unaddressed, including the need to reduce inequalities that exist in the health, education, social service, and justice systems that will ultimately support broad diffusion of EBIs for diverse populations.