Perceptions of Fidelity and Adaptation in Evidence-Informed Interventions by Women of Color Sexuality Health Educators

Abstract

Sexuality health educators (SHEs) adapt interventions to the participants’ needs in the dissemination and implementation of comprehensive sexuality education (CSE) programming. However, there is a lack of understanding of how, why and when SHEs make such adaptations. Success or failure of the transfer of prevention technology to practitioners occurs by determining community capacities and preparedness to adopt/adapt high-impact interventions to effectively manage implementation. Experts argue for evidence-informed interventions (EII), as opposed to evidence-based interventions (EBI), as the best way to incorporate research in applied settings. EBIs are solely guided by recommendations from current evidence, whereas EIIs recognize and incorporate the practitioner’s judgment and professional expertise in the context of program implementation. This exploratory study used qualitative methods, purposive sampling and an inductive approach. Semi-structured focus groups explored perceptions of adaptation and fidelity with women of color (WOC) SHEs currently implementing CSE behavioral interventions with young women of color (YWOC). Five focus groups were facilitated in total (one face-to-face, four virtually, via Google Hangouts); n=24, with an average of five participants per focus group. Focus groups were audio and video (online only) recorded, transcribed, and analyzed. The research team coded transcripts using Dedoose Qualitative Research Software, and conducted analysis using Grounded Theory methodology. Three dominant themes and sixteen related sub-themes were identified using a number of analytic approaches, including: simultaneous coding, values coding, calculating frequency, comparing and contrasting emerging themes, language comparison and language analysis (i.e. metaphors, analogies, similes), research team memos, and noting participants’ non-verbal cues. The dominant themes identified include: Professional Expertise, Socio-Cultural Understanding, and Situational Awareness. Key sub-themes included Curriculum Adaptation; Training; Approach; Interaction with Agency and Funding Staff; Pop Culture and Social Media; Themes Addressing Race, Culture, Colorism, and Related Biases; Trauma; Race/Ethnicity; Geographic Location; Community; and Group. An in-depth examination of the themes, sub-themes, related trends and similarities is discussed, along with implications for future research, policy and practice. Study findings demonstrate true intersectionality in the approach, methodology, and scope WOC SHEs use to implement and adapt CSE curricula. Furthermore, current monitoring and evaluation practices that prioritize high fidelity should be re-assessed and updated to reflect the lessons learned during implementation practice