Prevention Science

, Volume 20, Issue 7, pp 1074–1088 | Cite as

Addressing the Adherence-Adaptation Debate: Lessons from the Replication of an Evidence-Based Sexual Health Program in School Settings

  • Jenita ParekhEmail author
  • Elizabeth Stuart
  • Robert Blum
  • Valerie Caldas
  • Brooke Whitfield
  • Jacky M. Jennings


Whether high adherence to programs is necessary to achieve program outcomes is an area of great debate. The objectives of this study were to determine the frequency, type, and rationale of adaptations made in the implementation of an evidence-based program and to determine program outcomes for intervention program participants, as compared to comparison participants, by the level of adaptations. A total of 1608 participants in 45 classrooms participated. Percent adaptations was calculated by classroom. Thematic qualitative analysis was used to categorize types and rationales for adaptations. Program outcomes by level of adaptations were determined using logistic regression analyses and mean differences. Propensity score matching methods were used to create comparability between adaptation subgroup participants and comparison participants. Adaptations ranged from 2 to 97% across classrooms, with mean adaptations of 63%. Thematic analysis revealed that the adaptations made were related to delivery of content, rather than to the content itself and in response to participant needs and setting constraints. Program outcomes did not appear to be reduced for the high-adaptation subgroup. Understanding both rationale (intent) and type of adaptation made is crucial to understanding the complexity of adaptations. These finding support the argument for allowing facilitators some flexibility and autonomy to adapt the delivery of prescribed content to participant needs and setting constraints.


Program implementation Evidence-based program Sexual and reproductive health programs Adolescents Program implementation fidelity 



Its contents are solely the responsibility of the author and do not necessarily represent the official views of the funder. J. Parekh was supported by the National Institute of Allergy and Infectious Disease (NIAID T32 AI050056-12).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Johns Hopkins University’s IRB and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Funding Information

This project is supported by the Administration for Children and Families’ Family and Youth Services Bureau (FYSB), utilizing federal funds HHS-2010-ACF-ACYF-PREP-0125.


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Copyright information

© Society for Prevention Research 2019

Authors and Affiliations

  1. 1.The Department of Population, Family and Reproductive HealthThe Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.The Johns Hopkins Center for Child & Community HealthJohns Hopkins Bayview Medical CenterBaltimoreUSA
  3. 3.The Department of Mental HealthThe Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Child Trends, Inc.BethesdaUSA

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