How researchers adapted an evidence-based program

We talk a lot about how using “one-size-fits-all” programs or “programs in a box” is probably not the best way to prevent sexual and intimate partner violence in all of our diverse communities. An evidence-based program that was designed for mostly-white middle schoolers in a suburban area, for example, probably won’t be that effective for ethnically diverse college students in an urban area. But there’s also a strong trend toward doing prevention work that’s based in evidence – experiential, contextual, and research-based.

What I think is the most difficult part of planning evidence-based programming is bridging experiential and contextual evidence with research evidence. Even if we have a really deep understanding of our communities, it’s not necessarily easy to figure out how to use that understanding to make research-based programs fit.

A new research article by Vangie Foshee and others talks about how they went about adapting the Families for Safe Dates (FSD) program, which aims to give parents and their adolescent children a structured guide for talking about preventing teen dating violence. The adaptation of the program, called Mothers and Teens for Safe Dates (MTSD), was tailored to mothers who had left abusive relationships and their adolescents.

First, the researchers used logic and theory. There were a lot of elements in FSD that they didn’t think would be necessary for MTSD, such as conversations about the severity of the problem of dating violence, since both the mothers and teens would have experienced the problem first-hand. They also added more activities and emphasis to some areas they thought would be really important for this population.

Then, they did pilot testing with some families in the target population. First, they tried to go to local courts to recruit mothers who were getting protective orders, but they weren’t able to recruit many families. They used this contextual evidence to change their approach, and started recruiting families in different ways. Similarly, they started out doing focus groups with participants to get feedback on MTSD, but most of the families didn’t show up. So they cut out the need for participants to travel to a central location by doing phone interviews instead.

In these interviews, they asked participants all about their experiences with MTSD. They asked both mothers and teens what they thought about the program’s structure and content – what was interesting and what wasn’t, what was difficult to talk about, whether it was convenient, what they wished there were more of, and on and on. And they learned that though some of their logical and theory-based ideas for what to change were right, some of the elements that they took out were really still important for these mothers and teens. Participants also told the researchers that some of the things they emphasized should have been emphasized even more, which both illustrated the researchers’ understanding of the population and highlighted clear ways to make the program even more relevant. The researchers used all of this information to change MTSD before doing a full-scale study on the program.

What I love about this article is that the researchers didn’t just tell us how effective the new MTSD program is. They tell us how they got it to be right for the target population. We can use lessons from their process in our communities. Based on our understanding of our communities, we can make some informed guesses about what parts of evidence-based programs and risk and protective factors are and aren’t important for the community, and then, of course, actually check with the community. Even better, we can ask some members of the community what parts of a program they think are relevant to them, and then verify the changes we make with more members of the community. And when we find that something isn’t working for our community, like the court-based recruitment and focus groups in this study, we can change it.

It’s all about taking what works in research-based programs and making it work for us.

Full citation: Foshee, V.A., Dixon, K.S., Ennett, S.T., Moracco, K.E., Bowling, J.M., Chang, L.Y., & Moss, J.L. (2014). The process of adapting a universal dating abuse prevention program to adolescents exposed to domestic violence. Journal of Interpersonal Violence. Advance online publication.

Link: http://jiv.sagepub.com/content/early/2014/10/01/0886260514552278.abstract

Full abstract:

“Adolescents exposed to domestic violence are at increased risk of dating abuse, yet no evaluated dating abuse prevention programs have been designed specifically for this high-risk population. This article describes the process of adapting Families for Safe Dates (FSD), an evidenced-based universal dating abuse prevention program, to this high-risk population, including conducting 12 focus groups and 107 interviews with the target audience. FSD includes six booklets of dating abuse prevention information, and activities for parents and adolescents to do together at home. We adapted FSD for mothers who were victims of domestic violence, but who no longer lived with the abuser, to do with their adolescents who had been exposed to the violence. Through the adaptation process, we learned that families liked the program structure and valued being offered the program and that some of our initial assumptions about this population were incorrect. We identified practices and beliefs of mother victims and attributes of these adolescents that might increase their risk of dating abuse that we had not previously considered. In addition, we learned that some of the content of the original program generated negative family interactions for some. The findings demonstrate the utility of using a careful process to adapt evidence-based interventions (EBIs) to cultural sub-groups, particularly the importance of obtaining feedback on the program from the target audience. Others can follow this process to adapt EBIs to groups other than the ones for which the original EBI was designed.”