Prevention Science

, Volume 18, Issue 6, pp 640–648 | Cite as

Directions for the Advancement of Culturally Adapted Preventive Interventions: Local Adaptations, Engagement, and Sustainability

  • Manuel BarreraJr.Email author
  • Cady Berkel
  • Felipe González Castro


To advance the implementation and dissemination of culturally adapted interventions to diverse populations, greater attention should be devoted to three underdeveloped topics: (a) local adaptations of interventions when they are implemented in community settings, (b) participant engagement, and (c) the sustainability of adapted interventions. Several typologies have been developed for studying local adaptations, and some research indicates that such adaptations might add to intervention effectiveness. There is suggestive evidence of ethnocultural group disparities in intervention engagement and in the success of efforts to boost engagement. Theory and limited data indicate that interventions’ flexibility and fit with organizational culture and resources can be achieved through cultural adaptations. Furthermore, those adaptations should be associated with sustainability, but research has yet to test that hypothesis adequately. Several recommendations are made for advancing culturally adapted interventions through additional research on local adaptations during implementation, the many facets of participant engagement, and sustainability.


Cultural adaptation Local adaptation Engagement Sustainability 


Compliance with Ethical Standards


This article was funded in part by the Robert Wood Johnson Foundation (grant number 72241) awarded to Dr. Castro (PI).

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Because this article is a review and analysis of previously published literature, informed consent is not applicable.


  1. Aarons, G. A., Green, A. E., Palinkas, L. A., Self-Brown, S., Whitaker, D. J., Lutzker, J. R., Silovsky, J. F., Hecht, D. B., & Chaffin, M. J. (2012). Dynamic adaptation process to implement an evidence-based child maltreatment intervention. Implementation Science, 7, 1–9. doi: 10.1186/1748-5908-7-32.CrossRefGoogle Scholar
  2. Anyon, Y., Ong, S. L., & Whitaker, K. (2014). School-based mental health prevention for Asian American adolescents: Risk behaviors, protective factors, and service use. Asian American Journal of Psychology, 5, 134–144. doi: 10.1037/a0035300.CrossRefGoogle Scholar
  3. Baker, C. N., Arnold, D. H., & Meagher, S. (2011). Enrollment and attendance in a parent training prevention program for conduct problems. Prevention Science, 12, 126–138. doi: 10.1007/s11121-010-0187-0.CrossRefPubMedGoogle Scholar
  4. Barrera, M., Jr., & Castro, F. G. (2006). A heuristic framework for the cultural adaptation of interventions. Clinical Psychology: Science and Practice, 13, 311–316. doi: 10.1111/j.1468-2850.2006.00043.x.Google Scholar
  5. Bennett, G. G., & Glasgow, R. E. (2009). The delivery of public health interventions via the Internet: Actualizing their potential. Annual Review of Public Health, 30, 273–292. doi: 10.1146/annurev.publhealth.031308.100235.CrossRefPubMedGoogle Scholar
  6. Berkel, C., Mauricio, A. M., Schoenfelder, E., & Sandler, I. N. (2011). Putting the pieces together: An integrated model of program implementation. Prevention Science, 12, 23–33. doi: 10.1007/s11121-010-0186-1.CrossRefPubMedGoogle Scholar
  7. Berkel, C., Sandler, I. N., Brown, C. H., Gallo, C. G., Mauricio, A. M., Wolchik, S. A., & Jones, S. (2016). “Home practice is the program”: Correlates of parents’ practice of program skills in the New Beginnings Program effectiveness trial. Prevention Science.Google Scholar
  8. Bernal, G., Jimenez-Chafey, M. I., & Domenech Rodríquez, M. M. (2009). Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice, 40, 361–368. doi: 10.1037/a0016401.CrossRefGoogle Scholar
  9. Biglan, A., Mrazek, P. J., Carnine, D., & Flay, B. R. (2003). The integration of research and practice in the prevention of youth problem behaviors. American Psychologist, 58, 433–440. doi: 10.1037/0003-066X.58.6-7.433.CrossRefPubMedGoogle Scholar
  10. Blake, S. M., Simkin, L., Ledsky, R., Perkins, C., & Calabrese, J. M. (2001). Effects of a parent-child communications intervention on young adolescents’ risk for early onset of sexual intercourse. Family Planning Perspectives, 33, 52–61. doi: 10.2307/2673750.CrossRefPubMedGoogle Scholar
  11. Blakely, C. H., Mayer, J. P., Gottschalk, R. G., Schmitt, N., Davidson, W. S., Roitman, D. B., & Emshoff, J. G. (1987). The fidelity-adaptation debate: Implications for the implementation of public sector social programs. American Journal of Community Psychology, 15, 253–268. doi: 10.1007/BF00922697.CrossRefGoogle Scholar
  12. Cabassa, L. J., & Baumann, A. A. (2013). A two-way street: Bridging implementation science and cultural adaptations of mental health treatments. Implementation Science, 8, 1–14. doi: 10.1186/1748-5908-8-90.CrossRefGoogle Scholar
  13. Cardemil, E. V. (2010). Cultural adaptations to empirically supported treatments: A research agenda. Scientific Review of Mental Health Practice, 7, 8–21.Google Scholar
  14. Castro, F. G., Barrera, M., Jr., & Martinez, C. R., Jr. (2004). The cultural adaptation of prevention interventions: Resolving tensions between fidelity and fit. Prevention Science, 5, 41–45. doi: 10.1023/ Scholar
  15. Castro, F. G., Barrera, M., Jr., & Holleran Steiker, L. K. (2010). Issues and challenges in the design of culturally adapted evidence-based interventions. Annual Review of Clinical Psychology, 6, 213–239. doi: 10.1146/annurev-clinpsy-033109-132032.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: Addressing the paradox of sustainment amid ongoing change. Implementation Science, 8, 117. doi: 10.1186/1748-5908-8-117.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Chipungu, S. S., Hermann, J., Sambrano, S., Nistler, M., Sale, E., & Springer, J. F. (2000). Prevention programming for African American youth: A review of strategies in CSAP’s national cross-site evaluation of high-risk youth programs. Journal of Black Psychology, 26, 360–385. doi: 10.1177/0095798400026004002.CrossRefGoogle Scholar
  18. Clarke, A. T., Marshall, S. A., Mautone, J. A., Soffer, S. L., Jones, H. A., Costigan, T. E., Patterson, A., Jawad, A. F., & Power, T. J. (2013). Parent attendance and homework adherence predict response to a family–school intervention for children with ADHD. Journal of Clinical Child & Adolescent Psychology, 44, 58–67. doi: 10.1080/15374416.2013.794697.CrossRefGoogle Scholar
  19. Collins, L. M., Murphy, S. A., & Bierman, K. L. (2004). A conceptual framework for adaptive preventive interventions. Prevention Science, 5, 185–196. doi: 10.1023/B:PREV.0000037641.26017.00.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Collins, L. M., Kugler, K. C., & Gwadz, M. V. (2016). Optimization of multicomponent behavioral and biobehavioral interventions for the prevention and treatment of HIV/AIDS. AIDS & Behavior, 20, 197–214.CrossRefGoogle Scholar
  21. Cooper, B. R., Bumbarger, B. K., & Moore, J. E. (2015). Sustaining evidence-based prevention programs: Correlates in a large-scale dissemination initiative. Prevention Science, 16, 145–157.Google Scholar
  22. Cooper, B. R., Shrestha, G., Hyman, L., & Hill, L. (2016). Adaptations in a community-based family intervention: Replication of two coding schemes. Journal of Primary Prevention, 37, 33–52.Google Scholar
  23. Davidson, E. M., Liu, J. J., Bhopal, R., White, M., Johnson, M. R., Netto, G., Wabnitz, C., & Sheikh, A. (2013). Behavior change interventions to improve the health of racial and ethnic minority populations: A tool kit of adaptation approaches. Milbank Quarterly, 91, 811–851. doi: 10.1111/1468-0009.12034.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Dillman Carpentier, F., Mauricio, A. M., Gonzales, N. A., Millsap, R. E., Meza, C. M., Dumka, L. E., Germán, M., & Genalo, M. T. (2007). Engaging Mexican origin families in a school-based preventive intervention. Journal of Primary Prevention, 28, 521–546. doi: 10.1007/s10935-007-0110-z.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Du Bois, S. N., Johnson, S. E., & Mustanski, B. (2012). Examining racial and ethnic minority differences among YMSM during recruitment for an online HIV prevention intervention study. AIDS and Behavior, 16, 1430–1435. doi: 10.1007/s10461-011-0058-0.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Dumas, J. E., Nissley-Tsiopinis, J., & Moreland, A. D. (2007). From intent to enrollment, attendance, and participation in preventive parenting groups. Journal of Child & Family Studies, 16, 1–26. doi: 10.1007/s10826-006-9042-0.CrossRefGoogle Scholar
  27. Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41, 327–350. doi: 10.1007/s10464-008-9165-0.CrossRefPubMedGoogle Scholar
  28. Dusenbury, L., Brannigan, R., Falco, M., & Hansen, W. B. (2003). A review of research on fidelity of implementation: Implications for drug abuse prevention in school settings. Health Education Research, 18, 237–256. doi: 10.1093/her/18.2.237.CrossRefPubMedGoogle Scholar
  29. Dusenbury, L., Brannigan, R., Hansen, W. B., Walsh, J., & Falco, M. (2005). Quality of implementation: Developing measures crucial to understanding the diffusion of preventive interventions. Health Education Research, 20, 308–313. doi: 10.1093/her/cyg134.CrossRefPubMedGoogle Scholar
  30. Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89, 1322–1327. doi: 10.2105/AJPH.89.9.1322.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Gonzales, N. A., Lau, A., Murry, V., Pina, A., & Barrera, M., Jr. (2016). Culturally adapted preventive interventions for children and adolescents. In D. Cicchetti (Ed.), Developmental Psychopathology (3rd edition). doi: 10.1002/9781119125556.devpsy417.
  32. Haggerty, K. P., Skinner, M. L., MacKenzie, E. P., & Catalano, R. F. (2007). A randomized trial of parents who care: Effects on key outcomes at 24-month follow-up. Prevention Science, 8, 249–260. doi: 10.1007/s11121-007-0077-2.CrossRefPubMedGoogle Scholar
  33. Hansen, W. B., Pankratz, M. M., Dusenbury, L., Giles, S. M., Bishop, D. C., Albritton, J., Albritton, L. P., & Strack, J. (2013). Styles of adaptation: Impact of frequency and valence of adaptation on preventing substance use. Health Education, 113, 345–63. doi: 10.1108/09654281311329268.CrossRefGoogle Scholar
  34. Hill, L. G., Maucione, K., & Hod, B. K. (2007). A focused approach to assessing program fidelity. Prevention Science, 8, 25–34. doi: 10.1007/s11121-006-0051-4.CrossRefPubMedGoogle Scholar
  35. Johnson, K., Hays, C., Center, H., & Daley, C. (2004). Building capacity and sustainable prevention innovations: A sustainability planning model. Evaluation and Program Planning, 27, 135–149. doi: 10.1016/j.evalprogplan.2004.01.002.CrossRefGoogle Scholar
  36. Kumpfer, K. L., Alvarado, R., Smith, P., & Bellamy, N. (2002). Cultural sensitivity and adaptation in family-based prevention interventions. Prevention Science, 3, 241–246. doi: 10.1023/A:1021910199029.CrossRefPubMedGoogle Scholar
  37. Kumpfer, K. L., Pinyuchon, M., Melo, A. T., & Whiteside, H. O. (2008). Cultural adaptation process for international dissemination of the strengthening families program. Evaluation and the Health Professions, 31, 226–239. doi: 10.1177/0163278708315926.CrossRefPubMedGoogle Scholar
  38. Lau, A. S. (2006). Making a case for selective and directed cultural adaptations of evidence-based treatments: Examples from parent training. Clinical Psychology: Science and Practice, 13, 295–310. doi: 10.1111/j.1468-2850.2006.00042.x.Google Scholar
  39. Lee, S. J., Altschul, I., & Mowbray, C. T. (2008). Using planned adaptation to implement evidence-based programs with new populations. American Journal of Community Psychology, 41, 290–303. doi: 10.1007/s10464-008-9160-5.CrossRefPubMedGoogle Scholar
  40. Leviton, L. C. (2013). The template for systematic study of adaptations of evidence-based and evidence informed interventions. Robert Wood Johnson Foundation, unpublished.Google Scholar
  41. Mancini, J. A., & Marek, L. I. (2004). Sustaining community-based programs for families: Conceptualization and measurement. Family Relations, 53, 339–347. doi: 10.1111/j.0197-6664.2004.00040.x.CrossRefGoogle Scholar
  42. Mauricio, A. M., Tein, J.-Y., Gonzales, N., Millsap, R., Dumka, L., & Berkel, C. (2014). Participation patterns among Mexican-American parents enrolled in a universal intervention and their association with child externalizing outcomes. American Journal of Community Psychology, 54, 370–383. doi: 10.1007/s10464-014-9680-0.CrossRefPubMedGoogle Scholar
  43. McCabe, K., & Yeh, M. (2009). Parent-child interaction therapy for Mexican Americans: A randomized clinical trial. Journal of Clinical Child & Adolescent Psychology, 38, 753–759. doi: 10.1080/15374410903103544.CrossRefGoogle Scholar
  44. McGraw, S. A., Sellers, D. E., Johnson, C. C., Stone, E. J., Bachman, K. J., Bebchuk, J., & Edmundson, E. W. (1996). Using process data to explain outcomes an illustration from the Child and Adolescent Trial for Cardiovascular Health (CATCH). Evaluation Review, 20, 291–312. doi: 10.1177/0193841X9602000304.
  45. Miller-Day, M., Pettigrew, J., Hecht, M. L., Shin, Y., Graham, J., & Krieger, J. (2013). How prevention curricula are taught under real-world conditions: Types of and reasons for teacher curriculum adaptations. Health Education, 113, 324–344. doi: 10.1108/09654281311329259.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Moore, J. E., Bumbarger, B. K., & Cooper, B. R. (2013). Examining adaptations of evidence-based programs in natural contexts. The Journal of Primary Prevention, 34, 147–161. doi: 10.1007/s10935-013-0303-6.CrossRefPubMedGoogle Scholar
  47. Nix, R. L., Bierman, K. L., McMahon, R. J., & The Conduct Problems Prevention Research Group. (2009). How attendance and quality of participation affect treatment response to parent management training. Journal of Consulting & Clinical Psychology, 77, 429–438. doi: 10.1037/a0015028.CrossRefGoogle Scholar
  48. Orrell-Valente, J. K., Pinderhughes, E. E., Valente, E., & Laird, R. D. (1999). If it’s offered, will they come? Influences on parents’ participation in a community-based conduct problems prevention program. American Journal of Community Psychology, 27, 753–783. doi: 10.1023/A:1022258525075.CrossRefPubMedPubMedCentralGoogle Scholar
  49. Ozer, E. J., Wanis, M. G., & Bazell, N. (2010). Diffusion of school-based prevention programs in two urban districts: Adaptations, rationales, and suggestions for change. Prevention Science, 11, 42–55. doi: 10.1007/s11121-009-0148-7.CrossRefPubMedGoogle Scholar
  50. Perrino, T., Coatsworth, J. D., Briones, E., Pantin, H., & Szapocznik, J. (2001). Initial engagement in parent-centered preventive interventions: A family systems perspective. Journal of Primary Prevention, 22, 21–44. doi: 10.1023/A:1011036130341.CrossRefGoogle Scholar
  51. Rabin, B. A., Brownson, R. C., Haire-Joshu, D., Kreuter, M. W., & Weaver, N. L. (2008). A glossary for dissemination and implementation research in health. Journal of Public Health Management and Practice, 14, 117–123. doi: 10.1097/ Scholar
  52. Reid, M. J., Webster-Stratton, C., & Beauchaine, T. P. (2001). Parent training in head start: A comparison of program response among African American, Asian American, Caucasian, and Hispanic mothers. Prevention Science, 2, 209–227. doi: 10.1023/A:1013618309070.CrossRefPubMedGoogle Scholar
  53. Resnicow, K., Soler, R., Braithwaite, R. L., Ahluwalia, J. S., & Butler, J. (2000). Cultural sensitivity in substance use prevention. Journal of Community Psychology, 28, 271–290. doi: 10.1002/(SICI)1520-6629(200005)28:3<271::AID-JCOP4>3.0.CO;2-I.CrossRefGoogle Scholar
  54. Reyno, S. M., & McGrath, P. J. (2006). Predictors of parent training efficacy for child externalizing behavior problems—a meta-analytic review. Journal of Child Psychology & Psychiatry, 47, 99–111. doi: 10.1111/j.1469-7610.2005.01544.x.CrossRefGoogle Scholar
  55. Ringwalt, C. L., Vincus, A., Ennett, S., Johnson, R., & Rohrbach, L. A. (2004). Reasons for teachers’ adaptation of substance use prevention curricula in schools with non-white student populations. Prevention Science, 5, 61–67. doi: 10.1023/B:PREV.0000037642.40783.95.CrossRefPubMedGoogle Scholar
  56. Rogers, E. M. (1993). Diffusion and re-invention of project D.A.R.E. In T. E. Blacker & E. M. Rogers (Eds.), Organizational aspects of health communication campaigns: What works? (pp. 139–162). Newbury Park, CA: Sage.Google Scholar
  57. Rotheram-Borus, M. J., Swendeman, D., & Chorpita, B. (2012). Disruptive innovations for designing and diffusing evidence-based interventions. American Psychologist, 67, 463–476. doi: 10.1037/a0028180.CrossRefPubMedPubMedCentralGoogle Scholar
  58. Sandler, I., Wolchik, S., Berkel, C., Jones, S., Mauricio, A., Tein, J.-Y., Winslow, E. (under review). Effectiveness trial of the New Beginnings Program (NBP) for divorcing and separating parents: Translation from and experimental prototype to an evidence-based community service. In M. Israelashvili & J. L. Romano (Eds.), Cambridge Handbook of International Prevention Science. Cambridge: Cambridge University Press.Google Scholar
  59. Scheirer, M. A. (2005). Is sustainability possible? A review and commentary on empirical studies of program sustainability. American Journal of Evaluation, 26, 320–347. doi: 10.1177/1098214005278752.CrossRefGoogle Scholar
  60. Schoenfelder, E., Sandler, I. N., Millsap, R. E., Wolchik, S. A., Berkel, C., & Ayers, T. S. (2012). Responsiveness to the family bereavement program: What predicts responsiveness? What does responsiveness predict? Prevention Science, 14, 545–556. doi: 10.1007/s11121-012-0337-7.CrossRefGoogle Scholar
  61. Smith, J. D., Knoble, N. B., Zerr, A. A., Dishion, T. J., & Stormshak, E. A. (2014). Family check-up effects across diverse ethnic groups: Reducing early-adolescence antisocial behavior by reducing family conflict. Journal of Clinical Child & Adolescent Psychology, 43, 400–414. doi: 10.1080/15374416.2014.888670.CrossRefGoogle Scholar
  62. Spoth, R., Rohrbach, L. A., Greenberg, M., Leaf, P., Brown, C. H., Fagan, A., Catalano, R. F., Pentz, M. A., Sloboda, Z., Hawkins, J. D., & Society for Prevention Research Type 2 Translational Task Force Members and Contributing Authors. (2013). Addressing core challenges for the next generation of type 2 translation research and systems: The translation science to population impact (TSci Impact) framework. Prevention Science, 14, 319–351. doi: 10.1007/s11121-012-0362-6.CrossRefPubMedPubMedCentralGoogle Scholar
  63. Stirman, S. W., Miller, C. J., Toder, K., & Calloway, A. (2013). Development of a framework and coding system for modifications and adaptations of evidence-based interventions. Implemention Science, 8, 65. doi: 10.1186/1748-5908-8-65.CrossRefGoogle Scholar
  64. Sundell, K., Beelmann, A., Hasson, H., & von Thiele Schwarz, U. (2015). Novel programs, international adoptions, or contextual adaptations? Meta-analytical results from German and Swedish intervention research. Journal of Clinical Child & Adolescent Psychology. doi: 10.1080/15374416.2015.1020540.Google Scholar
  65. Swisher, J. D. (2000). Sustainability of prevention. Addictive Behaviors, 25, 965–973. doi: 10.1016/S0306-4603(00)00124-6.CrossRefPubMedGoogle Scholar
  66. Turner, K. M. T., Richards, M., & Sanders, M. R. (2007). Randomised clinical trial of a group parent education programme for Australian indigenous families. Journal of Paediatrics & Child Health, 43, 429–437. doi: 10.1111/j.1440-1754.2007.01053.x.CrossRefGoogle Scholar
  67. Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., Bearman, S. K., Daleiden, E. L., Ugueto, A. M., Ho, A., Martin, J., Gray, J., Alleyne, A., Langer, D. A., Southam-Gerow, M. A., Gibbons, R. D., & Research Network on Youth Mental Health. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial. Archives of General Psychiatry, 69, 274–82. doi: 10.1001/archgenpsychiatry.2011.147.CrossRefPubMedGoogle Scholar
  68. Wiltsey Stirman, S., Kimberly, J., Cook, N., Calloway, A., Castro, F., & Charns, M. (2012). The sustainability of new programs and innovations: A review of the empirical literature and recommendations for future research. Implementation Science, 7, 1–19. doi: 10.1186/1748-5908-7-17.CrossRefGoogle Scholar

Copyright information

© Society for Prevention Research 2016

Authors and Affiliations

  1. 1.Psychology DepartmentArizona State UniversityTempeUSA

Personalised recommendations