Developing Stronger ESMs

Addressing the Needs of Your Populations: Adopting or Adapting Strategies

Once the evidence has been considered for what works generally (see how to Accelerate Progress with Evidence), it is important to understand if a specific strategy will work for targeted populations, especially those most affected by health issues. Implementation science helps to translate the science into programs and policies that impact health outcomes in light of multiple social determinants. In finding strategies to meet needs, we have the ability to adopt and/or adapt what works.

ADOPT Strategies to Meet Needs

In choosing to adopt an existing strategy based on existing science and practice, we should consider:²

Is the study sample or population similar to our target audience?

Geography
Demographic characteristics
Culture, values, and preference
Health status
Other characteristics of interest

Do we have the resources needed to implement?

Workforce capacity
Money
Time
Leadership

Does our organization and the broader environment support the strategy? 

Political support
Financial and legal support
Champions for intervention
Community norms and partnerships
Title V priority and jurisdiction
Favorable environment for change

Implementation Tool. The Hexagon Tool (National Implementation Research Network) provides a systematic approach to evaluation effectiveness of a strategy based on six fit and feasibility factors.

Note. Looking at the evidence may not be sufficient to identify next steps if through this process we identify that the proposed strategy(s) does not:

Fit local context
Present sufficient evidence
Offer enough information about implementation and plans for replication
Have the ability to be modified for immediate use or for varied stakeholders

If this is the case, we recommend using the Science-Based Intervention Approach below to adapt strategies to fit the needs of your populations.

ADAPT Strategies to Meet Needs

Not all strategies are effective for all populations. To adapt strategies to meet needs, we should consider:²

What about the existing strategy works? If we understand the key ingredients of a strategy, we can replicate and/or adapt the effective components. Looking at a strategy through a health behavior theory identifies key ingredients. Here are several to consider:

Intrapersonal. Theory of Planned Behavior, Health Belief Model, Stages of Change Model.
Interpersonal. Social Cognitive Theory, Social Norms Theory.
Community. Diffusion of Innovation, Ecological Models.

How does it work? Being specific about the underlying mechanisms can help us increase the impact. Developing a logic model with program actions, targets, outcomes, and moderators allows you track the process from action to outcome.

For whom does it work, and for whom does it not work? When we know who is and is not responding, we can make targeted adaptations to improve outcomes. Think about the program life cycle:

Precision. Understand what a strategy entails so you can go beyond “does it work,” to “what about it works” and “for whom does it work.”
Fast-cycle iteration. Incorporate new ideas as you go – what is working and what is not working.
Shared learning. Create a mechanism to share learning about success and failures.
Co-creation. Bring together multiple parties to create a mutually valued outcome.

In what contexts does it work? By evaluating the context in which a strategy is implemented, we can adapt it for other settings. The best way to ensure that a strategy is effective is to conduct a robust evaluation. The MCH Navigator’s Evaluation Spotlight provides trainings and resources related to the steps and standards for effective program evaluation.

References

¹ Jacobs JA, Jones E, Gabella BA, Spring B, Brownson RC. Tools for implementing an evidence-based approach in public health practice. Prev Chronic Dis. 2012;9:110324.
² Adapted from IDEAS Impact Framework, Center on the Developing Child, Harvard University. 6Hayden J. Introduction to Health Behavior Theory, Second Edition. Burlington, MA: Jones & Bartlett Learning. 2014.