Evidence-Based Practices for
Healthiest Wisconsin 2010

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Implementing Evidence-based Practices

Identifying evidence-based practices (EBP) is only the first step toward increasing the likelihood that a policy or program intervention will be effective. Evidence for effectiveness is typically generated under relatively ideal conditions of implementation in which care is taken to assure that all elements of a program model are carefully applied. In medical research, there is a distinction between "efficacy" trials (in which a clinical intervention or drug is tested under ideal controlled circumstances) and "effectiveness" trials, in which an efficacious intervention is tested on a larger scale in real-world circumstances. The evidence for many of the EBP reviewed on this Web site falls somewhere between efficacy and effectiveness trials. To increase the likelihood that previously demonstrated outcomes will be attained in community implementations, care must be taken to assure that all critical components of the EBP are put in place with fidelity to the original intervention (see Durlak, 1998; Elliott and Mihalic, 2004).

The literature on program fidelity suggests that there is large-scale implementation failure as EBP are implemented in the community (e.g., Tobler and Stratton, 1997; Ringwalt, et al., 2004). Programs are often delivered with less intensity than the original, with new and possibly contradictory content added, with differing levels of care in following guidelines or manuals at different sites or by different staff members, or may be provided to diverse target populations for whom the practice has not been tested (Ringwalt, et al., 2004). There seems to be a psychological need to "reinvent" innovations (Rogers, 1995); coupled with the often justified perception that programs, policies and practices need to be adapted to local needs and circumstances.

Thus, implementation of an EBP does not guarantee effectiveness. When program developers provide guidelines on what elements of the intervention are essential and which can be adapted, this guidance should be followed. If the program has only been tested with one target population, care needs to be taken in adapting the intervention for other groups (Castro, Barrera and Martinez, 2004). Finally, implementation fidelity needs to be monitored with process evaluation and quality assurance techniques to assure that the intended EBP is, in fact, what is delivered.

References:

Castro FG, Barrera M Jr, Martinez CR Jr. The cultural adaptation of prevention interventions: resolving tensions between fidelity and fit. Prevention Science 2004; 5 (1), 41-45.

Durlak JA. Why program implementation is important. Journal of Prevention & Intervention in the Community. 1998; 17 (2), 5-18.

Elliot DS, Mihalic S. Issues in disseminating and replicating effective prevention programs. Prevention Science. 2004; 5 (1), 47-53.

Ringwalt CL, Vincus A, Ennett S, Johnson R, Rohrbach LA. Reasons for teachers' adaptation of substance use prevention curricula in schools with non-white student populations. Prevention Science. 2004; 5, 61-67.

Rogers EM. Diffusion of innovations. 1995; New York: Free Press.

Tobler NS, Stratton HH. Effectiveness of school-based drug prevention programs: A meta-analysis of the research. The Journal of Primary Prevention. 1997; 18 (1) 71-128.

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Last Revised: October 04, 2005