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Step 4: Implement

Step 4 of the Strategic Prevention Framework (SPF) helps prevention professionals deliver evidence-based interventions.

During implementation, prevention professionals put their strategic prevention plans into action by delivering their selected, evidence-based interventions. To implement programs and strategies effectively, practitioners need to:

Develop a Clear Action Plan

An action plan is a document that lays out exactly how you will implement a selected program, policy, or strategy. It describes what you expect to accomplish, the specific steps you will take to get there, and who will be responsible for doing what.

Work with your implementation partners—those individuals and organizations that will be responsible for or involved in program delivery to develop your plan. Doing so will help to ensure that everyone is on the same page and no key tasks fall through the cracks. In some cases, partners will want to make changes to the plan. Even if they don’t, it’s important to communicate openly and make sure that all partners are onboard with the implementation plan as you move forward.

Balance Fidelity and Adaptation

As you prepare to implement your selected prevention interventions, it is important to consider issues of fidelity and adaptation:

  • Fidelity describes the degree to which a program or practice is implemented as intended.
  • Adaptation describes how much, and in what ways, a program or practice is changed to meet local circumstances.

Evidence‐based programs are defined as such because they consistently achieve positive outcomes. The greater your fidelity to the original program design, the more likely you are to reproduce these positive results. Customizing a program to better reflect the attitudes, beliefs, experiences, and values of your focus population can increase its cultural relevance. However, it’s important to keep in mind that such adaptations may compromise program effectiveness.

Remaining faithful to the original evidence-based design while addressing the unique needs and characteristics of your target audience requires balancing fidelity and adaptation. When you change an intervention, you risk compromising outcomes. However, implementing a program that requires some adaptation may be more efficient and cost-effective than designing a program from scratch.

Here are some guidelines to consider when balancing fidelity and adaptation:

  • Retain core components: Evidence‐based programs are more likely to be effective when their core components (that is, those elements responsible for producing positive outcomes) are maintained. Core components are like the key ingredients in a cookie recipe. You may be able to omit the nuts, but if you leave out the flour the recipe won’t work! Here are some general guidelines for maintaining core components:
    • Preserve the setting as well as the number and length of sessions
    • Preserve key program content: It’s safer to add rather than subtract content
    • Add new content with care: Consider program guidance and prevention research
  • Build capacity before changing the program: Rather than change a program to fit with local conditions, consider ways to develop the resources or build local readiness so you can deliver the program as it was originally designed.
  • Add rather than subtract: Doing so will decrease the likelihood that you are eliminating a program element that is important (that is, critical to program effectiveness).
  • Adapt with care. Even when interventions are selected with great care, there may be ways to improve a program’s appropriateness for a unique focus population. Cultural adaptation refers to program modifications that are tailored to the values, attitudes, beliefs, and experiences of the target audience. To make an intervention more culturally appropriate, it is crucial to consider the language, values, attitudes, beliefs, and experiences of focus population members. Learn more about cultural competence.
  • If adapting, consult experts first: Experts can include the program developer, an environmental strategies specialist, or your evaluator. They may be able to tell you how the intervention has been adapted in the past and how well (or not) those adaptations worked. For cultural adaptations, you will also want to consult with cultural leaders and members of your focus population.

Establish Implementation Supports

Many factors combine to influence the implementation and support the success of prevention interventions, including the following:

  • Favorable prevention history: An individual or organization with positive experiences implementing prevention interventions in the past will likely be more ready, willing, and able to support the implementation of a new intervention. If an individual or organization has had a negative experience with—or doesn’t fully understand the potential of—a prevention intervention, then it will be important to address these concerns early in the implementation process.
  • Onsite leadership and administrative support: Prevention interventions assume many different forms and are implemented in many different settings. To be effective, interventions require leadership and support from key stakeholders.
  • Practitioner selection: When selecting the best candidate to deliver a prevention intervention, consider professional qualifications and experiences, practical skills, as well as fit with your focus population.
  • Practitioner training and support: Pre‐and in‐service trainings can help practitioners responsible for implementing an intervention understand how and why the intervention works, practice new skills, and receive constructive feedback. Since most skills are learned on the job, it is also very helpful to connect these practitioners with a coach who can provide ongoing support.
  • Program evaluation: By closely monitoring and evaluating the delivery of an intervention, practitioners can make sure that it is being implemented as intended and improve it as needed. By assessing program outcomes, they can determine whether the intervention is working as intended and worthy of sustaining over time.

When prevention practitioners promote both fidelity and cultural relevance, and anticipate and support the many factors that influence implementation, these efforts go a long way toward producing positive outcomes. But to sustain these outcomes over time, it is important to get others involved and invested in the prevention interventions. Find concrete and meaningful ways for people to get involved, keep cultural and public opinion leaders well‐informed, and get the word out to the broader community through media and other publicity efforts.

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Last Updated: 09/30/2016