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Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences
Price, 1989). Core elements are features of an intervention program or policy that must be replicated to maintain the integrity of the interventions as they are transferred to new settings. They include theoretically based behavior change strategies, targeting of multiple levels of influence, and the involvement of empowered community leaders (Florin and Wandersman, 1990; Pentz, 1998). Practitioners need training in specific strategies for the transfer of core elements (Bero et al., 1998; Orlandi, 1986). In addition, the amount of intervention delivered and its reach into the targeted population might have to be unaltered to replicate behavior change in a new setting. Research has not established a quantitative “dose” of intervention or a quantitative guide for the percentage of core elements that must be implemented to achieve behavior change. Process evaluation can provide guidance regarding the desired intensity and fidelity to intervention protocol. Botvin and colleagues (1995), for example, found that at least half the prevention program sessions needed to be delivered to achieve the targeted effects in a youth drug abuse prevention program. They also found that increased prevention effects were associated with fidelity to the intervention protocol, which included standardized training of those implementing the program, implementation within 2 weeks of that training, and delivery of at least two program sessions or activities per week (Botvin et al., 1995).
Adaptive elements are features of an intervention that can be tailored to local community, organizational, social, and economic realities of a new setting without diluting the effectiveness of the intervention (Price, 1989). Adaptations might include timing and scheduling or culturally meaningful themes through which the educational and behavior change strategies are delivered.
Community and Organizational Readiness
Community and organizational factors might facilitate or hinder the adoption, implementation, and maintenance of innovative interventions. Diffusion theory assumes that the unique characteristics of the adopter (such as community, school, or worksite) interact with the specific attributes of the innovation (risk factor targets) to determine whether and when an innovation is adopted and implemented (Emmons et al., 2000; Rogers, 1983, 1995). Rogers (1983, 1995) has identified characteristics that predict the adoption of innovations in communities and organizations. For example, an innovation that has a relative advantage over the