STAGE 5. Defining the action plan

What steps should be completed?

Step 1: Specify intervention actions

DESIGNING AND ADAPTING INTERVENTION STRATEGIES

When planning intervention strategies, a number of characteristics should be taken into account, whether they are unpublished (new) actions or actions adapted from other interventions:

• The characteristics of the population.
• The needs assessment.
• The personal and contextual determinants you wish to modify.
• The place of implementation.
• The people who will apply the intervention.
• The resources available for the intervention.

The most appropriate type and intensity of intervention strategy must be determined. Strategies are derived from specific methodological approaches that suggest more appropriate ways to achieve change in the population. For example, modelling can lead to some common activities, such as role-playing or skills training workshops, as strategies to teach new behaviours. The intensity (or dose) is also related to an intervention’s ability to cause change so it is important understand and define the minimum time, duration and frequency of the actions required to have an effect on the population.

Strategies to prepare the intervention are also important. These include training administrators, choosing materials, disseminating activities, and recruiting and retaining the population.

Adapting programmes^1,2

It is becoming more and more common to adapt programmes that have already demonstrated their efficacy in other contexts. This task can raise some doubts, such as whether the intervention is equally feasible when applied to a different environment, or questions about the degree of fidelity to the original that would be necessary for the actions to modify the determinants of drug-related behaviours in the target population. However, adapting activities that have proven effective undoubtedly offers more guarantees than creating new actions whose effects are unknown. The European Monitoring Centre for Drugs and Drug Addiction recently published a review of North American programmes in European countries and concluded that programmes that adapt satisfactorily and conform to other cultural contexts do work correctly.¹ An appropriate adaptation ensures that the basic principles for the intervention to work are culturally adapted for transmission.

The following tasks can be considered good practice in programme adaptation:

• Studying the causes of drug use in the population to guide the adaptation process. Analysis of needs and feasibility will be two key instruments to obtain the information needed in this process.
• Translating and modifying (or deleting) text, images, names and examples, and adapting colloquial expressions in the materials to local language and ensuring that they are culturally relevant to so that the target population listens to the message. It is also important to identify the cultural norms of behavioural patterns and produce cultural definitions of hazardous behaviour. A team of professionals from the field of health, publicity and, above all, members of the population subject to the intervention can be created to do this.
• Adapting the structure of the intervention (without compromising validity) to the political, organisational and social context of the region.
• Evaluating the process and results of the programme to make ongoing relevant cultural readaptations.
• Developing pilot tests. Whether designing a new intervention or adapting an action strategy, it is highly advisable to produce a pilot test, i.e., a small-scale study on the suitability, approval, adequacy and understanding of the intervention, prior to its implementation. The pilot will provide fundamental information on whether the intervention is suited to the social and cultural values, practices and characteristics of the target population.

During the process of adapting a programme, special attention should also be paid to the type, content (health), number, duration and sequence of sessions, as they are usually the key structural elements to achieve the desired results. Adapting an intervention that has previously been implemented with positive results in a population with characteristics as similar as possible to the one that will now be targeted is also extremely important.

When designing your intervention, it could be useful to consult information on different portals on drug demand reduction, such as:

• The best practice portal. EMCDDA  
• National registry of evidence-based programs and practices. SAMHSA

 

References:

1 Burkhart G. (2013). North American drug prevention programmes: are they feasible in European cultures and contexts? EMCDDA. Luxembourg: Publication Office of the European Union.

2 Ferrer-Wreder l, Sundell K, Mansoory S. (2012). Tinkering with perfection: theory development in the intervention cultural adaptation field. Child youth care forum. 41: 149-171.