program adaptation, based on evidence that delivery of evidence-based programs as designed is likely to lead to the most successful prevention efforts.

Adaptation of an Existing Program to the Community

Adaptation of programs focuses on concerns about community or cultural relevance. A community identifies an evidence-based program that matches its needs, values, and resources and modifies or adopts elements of the program to maximize community acceptance, implementation, and sustainability. Researchers often work in close collaboration with community leaders to find ways to integrate components of prevention programs in ways that are acceptable and meaningful to the community and to evaluate results.

There is long-standing consensus that health promotion and prevention programs should be culturally sensitive, along with concerns about whether a given prevention intervention is generic enough to be efficacious and effective with diverse cultures (Resnicow, Baranowski, et al., 1999; Seto, 2001; Woods, Montgomery, and Herring, 2004; Weeks, Schensul, et al., 1995; Hutchinson and Cooney, 1998). Prevention programs must also be mindful of developmental processes, reinforcements of risk behavior, relevant contextual factors, and a population’s unique risk profile (Brown, DiClemente, and Park, 1992).

A few studies have shown that making adaptations to different cultural groups while maintaining core elements of programs implemented with fidelity can produce strong results across different cultural groups (Botvin, Schinke, et al., 1994; Botvin, Baker, et al., 1995; Botvin, Schinke, et al., 1995; Reid, Webster-Stratton, and Beauchaine, 2001). However, there is currently no consensus and limited scientific evidence on the key elements that determine the necessary balance between program adaptation and program fidelity.

Bell, Bhana, and colleagues (2008) point out that, for an intervention to be culturally sensitive, it must have content that is welcoming to the target culture, contain issues of relevance to the culture, not be offensive, and be familiar to and endorsed by the culture. If a given intervention embodies generic principles of health behavior change, such as aspects that create social fabric, generate connectedness, help develop social skills, build self-esteem, facilitate some social monitoring, and help minimize trauma (Bell, Flay, and Paikoff, 2002), it can usually be adapted to have an appropriate level of cultural sensitivity (Bhana, Petersen, et al., 2004; Peterson, 2004; LaFromboise and Lewis, 2008; LaFromboise, 1995). For example, if going on a spirit quest builds self-esteem in American Indian culture, efforts to build self-esteem in American Indians might best be served by a spirit quest exercise instead of formation of a soccer team (Bell, 2005; see also



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