C-CHANGE
C-Channel:
Issue 36 | DECEMBER 2011
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More Peer-Reviewed Articles on Adapting SBCC Programs and Activities

Of Interest…

C-Change staff authored an article titled “Gender norms and family planning decision-making in Tanzania: A qualitative study” in the September 2011 issue of Journal of Public Health in Africa. Findings were based on in-depth interviews and focus group discussions with young, married men and women and older people who influence family planning decisions.

C-Channel 36 presents seven more articles on adapting social and behavior change communication (SBCC) programs and activities to other settings. (C-Channel 35 presented articles on adaptations in sub-Saharan Africa.) The first outlines a sexual and reproductive health program for specific groups in Guatemala; the second an adaptation of a US youth HIV prevention program in China; and the next two report on adaptations for US minority populations. The next three articles are more theoretical. One proposes seven steps to take in adapting HIV prevention programs; the next refers to tension between fidelity and adaptation and calls for a “science of replication;” and the last suggests intervention mapping is needed.

Readers seeking information about the implementation and adaptation of SBCC programs will find C-Picks useful. It is a bimonthly e-magazine highlighting SBCC resources, tools, strategic thinking, and case studies, and is collaboratively produced by Communication Initiative and C-Change

In this issue

Experience Adapting SBCC Programs and Activities

1. Sexual Health Communication Across and Within Cultures in Guatemala
ONLINE FULL TEXT

2. Effect of SCT-Based HIV Education Prevention Program among HS Students in China
PURCHASE FULL TEXT

3. Diffusion of School-Based Prevention Programs in Two Urban Districts
ONLINE FULL TEXT

4. Adapting Effective HIV-Prevention Interventions to Increase Minorities' Engagement
ONLINE FULL TEXT

Advice on Adapting SBCC Programs and Activities

5. How to Adapt Effective Programs for Use in New Contexts
ONLINE FULL TEXT

6. Replicating an Intervention: The Tension between Fidelity and Adaptation
ONLINE FULL TEXT

7. Decoding Health Education Interventions
PURCHASE FULL TEXT


Experience Adapting SBCC Programs and Activities

1. Sexual Health Communication Across and Within Cultures: the Clown Project, Guatemala

Authors: Savdié A1; Chetley A2
Institutions: 1 Panajachel Solola, Iximulew, Guatemala; 2 Healthlink, London, UK
Source: Development in Practice 2009. 19 (4-5): 560–572.

ABSTRACT

The synergies created through the careful application of both organic and symbolic communication demonstrably reach those most vulnerable to the spread and impact of HIV and AIDS. The Clown Project uses labour-intensive face-to-face street theatre and dialogue, participatory workshops, and symbolic communication such as print-based materials. Some lessons learned in selected communities in Guatemala and other countries in Central America are shared. This paper puts forward an argument in favour of careful and critical analysis of culture in formulating communication strategies with and for specific groups. This analysis takes into account relations of power within and between vulnerable groups, examining the centre–periphery dynamic between classes, genders, ethnicities, age groups, and other social identities. Both appropriately supported insider perspectives and appropriately processed outsider knowledge are recommended, along with ways of bridging science and the field, theory and practice.

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2. Effect of Social Cognitive Theory-Based HIV Education Prevention Program among High School Students in Nanjing, China

Authors: Li X1; Zhang L1; Mao R2; Zhao Q1; Stanton B1
Institutions: 1 Prevention Research Center, Wayne State University School of Medicine, Detroit, Mi USA; 2 Nanjing University Institute of Mental Health, Nanjing, Jiangsu, China
Source: Health Education Research 2011 26 (3): 419–431.

ABSTRACT

This study was designed to evaluate potential preventive effects of a cultural adaption of the Focus on Kids (FOK) program among Chinese adolescents through a quasi-experimental intervention trial in Nanjing, China. High school students were assigned to either experimental groups (n = 140) or control groups (n = 164) by schools (with three schools in each condition). The participants completed a confidential questionnaire at baseline and 6-month post-intervention with a follow-up rate of 94.4% (287 of 304). The outcome measures included HIV knowledge, HIV-related perceptions based on the protection motivation theory, stigmatizing attitude toward people living with HIV/AIDS (PLWHA), intentions of health-related risk behaviors and sexual intercourse in the previous 6 months. Results showed a significant intervention effect at 6-month post-intervention in increasing HIV knowledge, decreasing perceptions of response cost associated with abstinence and reducing stigmatizing attitudes toward PLWHA, after controlling for key demographic characteristics and relevant baseline measures. Further mediation analysis suggested that HIV knowledge mediated the effect of intervention on stigma reduction. Findings from this study support the feasibility and initial efficacy of the cultural adaptation of FOK HIV prevention program among high school students in China.

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3. Diffusion of School-Based Prevention Programs in Two Urban Districts: Adaptations, Rationales, and Suggestions for Change

Authors: Ozer E; Wanis M; Bazell N
Institution: School of Public Health, University of California at Berkeley, USA
Source: Prevention Science 2010, 11(1): 42–55.

ABSTRACT

The diffusion of school-based preventive interventions involves the balancing of high-fidelity implementation of empirically-supported programs with flexibility to permit local stakeholders to target the specific needs of their youth. There has been little systematic research that directly seeks to integrate research- and community-driven approaches to diffusion. The present study provides a primarily qualitative investigation of the initial roll-out of two empirically-supported substance and violence prevention programs in two urban school districts that serve a high proportion of low-income, ethnic minority youth. The predominant ethnic group in most of our study schools was Asian American, followed by smaller numbers of Latinos, African Americans, and European Americans. We examined the adaptations made by experienced health teachers as they implemented the programs, the elicitation of suggested adaptations to the curricula from student and teacher stakeholders, and the evaluation of the consistency of these suggested adaptations with the core components of the programs. Data sources include extensive classroom observations of curricula delivery and interviews with students, teachers, and program developers. All health teachers made adaptations, primarily with respect to instructional format, integration of real-life experiences into the curriculum, and supplementation with additional resources; pedagogical and class management issues were cited as the rationale for these changes. Students and teachers were equally likely to propose adaptations that met with the program developers’ approval with respect to program theory and implementation logistics. Tensions between teaching practice and prevention science—as well as implications for future research and practice in school-based prevention—are considered.

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4. Adapting Effective Narrative-Based HIV-Prevention Interventions to Increase Minorities' Engagement in HIV/AIDS Services

Authors: Berkley-Patton J1;Goggin K1; Liston R1; Bradley-Ewing A1; Neville S2
Institutions: 1 Department of Psychology, University of Missouri-Kansas City, USA; 2 Kansas City Free Health Clinic, Missouri, USA
Source: Health Communication 2009, 24(3): 199–209.

ABSTRACT

Disparities related to barriers to caring for HIV-positive and at-risk minorities continue to be a major public health problem. Adaptation of efficacious HIV-prevention interventions for use as health communication innovations is a promising approach for increasing minorities' utilization of HIV health and ancillary services. Role-model stories, a widely-used HIV-prevention strategy, employ culturally tailored narratives to depict experiences of an individual modeling health-risk reduction behaviors. This article describes the careful development of a contextually appropriate role model story focused on increasing minorities' engagement in HIV/AIDS health and related services. Findings from interviews with community members and focus groups with HIV-positive minorities indicated several barriers and facilitators related to engagement in HIV health care and disease management (e.g., patient–provider relationships) and guided the development of role-model story narratives.

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Advice on Adapting SBCC Programs and Activities

5. How to Adapt Effective Programs for Use in New Contexts

Authors: Card J1; Solomon J2; Cunningham S1
Institutions: 1 Sociometrics Corporation, Los Altos, Ca., USA; 2 J. Solomon Consulting, Mountain View, Ca., USA
Source: Health Promotion Practice 2011, 12(1): 25-35.

ABSTRACT

A wide variety of underused effective HIV prevention programs exist. This article describes sources for obtaining such effective programs and issues to consider in selecting an existing effective program for use with one’s priority population. It also discusses seven steps involved in adapting an effective program to meet the needs of a new context while preserving core components (what made, or is believed to have made, the intervention effective in the first place) and best practices (characteristics common to effective programs). Although the examples presented are from the HIV prevention field, the seven-step framework is applicable to the adaptation of effective programs in other health promotion and disease prevention arenas.

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6. Replicating an Intervention: The Tension between Fidelity and Adaptation

Authors: Morrison D1; Hoppe M1; Gillmore M2; Kluver C1; Higa D1; Wells E1
Institutions: 1 School of Social Work, University of Washington, USA; 2 School of Social Work, Arizona State University, USA.
Source: AIDS Education and Prevention 2009, 21(2):128–40.

ABSTRACT

Increased awareness of the importance of tailoring interventions to participants' cultures has focused attention on the limited generalizability of a single test of an intervention to determine efficacy. Adaptation is often necessary to replicate interventions across cultures. This produces a tension between fidelity to the original intervention and adaptations necessary to make the intervention relevant to the culture and circumstances of participants. This article discusses issues that arise during the course of replication, with illustrations from a replication to test the efficacy of an HIV prevention intervention for youth, using a randomized controlled design. Analysis of the issues raised leads us to suggest that a "science of replication" needs to be developed.

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7. Decoding Health Education Interventions: The Times Are a-Changin’

Authors: Schaalma H; Kok G
Institution: Maastricht University, the Netherlands
Source: Psychology & Health 2009 24(1):5–9.

ABSTRACT

The development of theory- and evidence-based health education interventions is a complex process in which interventionists in collaboration with priority groups and stakeholders make many decisions about objectives, change techniques, intervention materials and activities, delivery modes and implementation issues. In this development process, interventionists have to find a balance between employing change techniques that should be effective in an ideal world, and intervention activities and materials that match the reality of priority populations and intervention contexts. Intervention descriptions providing information about what behaviour change techniques have been employed, do not reflect the complexity of this decision-making process. They do not reveal why interventionists have decided to include or exclude particular behaviour change techniques. They do not reveal that interventions are based not only upon considerations of health psychologists and other scientists, but also on practical and political boundaries and opportunities that set the scene for the effectiveness of change techniques. Intervention descriptions should therefore reveal not only what is included in the interventions, but also why the intervention is as it is. Intervention Mapping provides the tools that enable the production of such descriptions.

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This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of C-Change, and do not necessarily reflect the views of USAID or the United States Government.

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