Cultural adaptation of programmes in addiction treatment and prevention

For various reasons, a promising evidence-based program designed for a certain population cannot be as effective for another population. Some authors advocate that specific programs should be designed for specific populations (August et al., 2004; Sanders et Turner, 2005), while others favour cultural adaptation of existing programs (Biglan, Mrazek, Carnine et Flay, 2003; Kumpfer et Kaftarian, 2000). Certainly, cultural adaptation of a program must be justified by one or more of the following reasons: (a) low clinical engagement, (b) presence of a risk or protection factor that is unique to the targeted population, (c) issue that is unique to the targeted population, and (d) absence of efficient intervention for the targeted population. The main challenge in culturally adapting a program lies in the delicate balance that exists between maintaining the key components ensuring the program’s effectiveness and the introduction, modification, or removal of elements to adapt the program to the culture of the targeted culture or sub-culture (Kumpfer et al., 2008). Two objectives are therefore opposed: (a) ensuring fidelity in the implementation of a prevention program that is recognized as effective, and (b) ensuring that the prevention program fits the specific needs of the population that it serves (Castro et al., 2004).

Drawing from significant experience in adapting addiction prevention programs to the aboriginal communities of Quebec, this presentation offers a reflection on the cultural adaptation process in attempt to answer these four questions: (1) Is cultural adaptation of an evidence-based program justifiable? (2) When conducting cultural adaptation, which procedures should be followed? (3) Is cultural adaptation effective? (4) Given the heterogeneity of the various cultural groups, how can the cultural adaptation of a program accommodate all participants involved? For this purpose, main tensions between fidelity and fit identified by Castro, Barrera and Martinez (2004) as well as four cultural adaptation models will be presented. In the light of the experience of culturally adapting the Sage Usage program through a collaborative knowledge building process, the model in 11 steps developed by Backer (2001), the model in 9 steps developed by Kumpfer et al. (2008), the model in 5 steps developed by McKleroy et al. (2006), and the model in 8 steps developed by Wingwood et DiClemente (2008) will be illustrated and compared.