What do we mean by "adaptation?" What do we mean by "different cultures and communities?" Why should you adapt interventions? When should you adapt interventions? An important question: Does an intervention always need to be adapted? How should you adapt interventions? Some special situations: "What should I do if...?" What do we mean by "adaptation"? Suppose you have conducted a community intervention and it is successful. Naturally, you might think about building upon your success and using the intervention elsewhere -- in a community or setting that may differ in culture, history, language, resources, geography, or other important ways. For example, suppose you have organized a successful park clean-up, voter registration drive, or home-visiting program for older adults. The park becomes clean; voters are registered; and visits are being made. Now there's a chance to use a similar approach in another setting, with a different community. Will your success be repeated? The key questions here are (1) whether that intervention will be successful elsewhere, and especially (2) how it can be made most relevant and effective in the new setting. The best answers are (1) "maybe," and (2) "with careful thinking, community involvement, and planning." The basic idea is that interventions are not always one-size-fits-all. When the setting is different, they may need to be adapted. Adaptation means modifying an intervention so that it fits the strengths, priorities, culture, circumstances, and resources of the community while preserving the elements that make the intervention effective. That is the main focus of this Tool Box section. What do we mean by "different cultures and communities?" "Culture" is a broad term that can include shared values, beliefs, practices, traditions, languages, histories, relationships, identities, and ways of understanding and interacting with the world. Culture is not fixed, and people who share one identity or background may still differ greatly from one another. Race and ethnicity can be important parts of cultural identity, but they should not be treated as if every racial or ethnic group has a single culture. People who identify as Black, Latino or Hispanic, Asian, Indigenous, White, or with another racial or ethnic identity may have many different cultural traditions, languages, histories, experiences, and perspectives within those broad categories. Cultural differences can also be connected to age, gender, socioeconomic circumstances, religion or spirituality, region, sexual orientation, disability, immigration experience, profession, family background, neighborhood, or combinations of these and other factors. A potluck supper, blood-pressure screening, or immunization drive might be a terrific success in one setting while the same event could receive little participation in another. Differences in relationships, communication preferences, accessibility, history, trust, timing, location, and community priorities may all affect how well an intervention fits. Why should you adapt interventions to fit different cultures and communities? Possibly the most important reason you might want to adapt your intervention is because your intervention has worked already and you would like it to work well in another setting. A well-adapted intervention can: Show respect for a community's values, identities, strengths, and experiences Improve your ability to connect and build relationships with the community you hope to engage Increase the relevance and accessibility of your actions Reduce the possibility of unintended or unexpected consequences Increase meaningful involvement and participation from community members Increase community understanding and support for your program, even among people who do not participate directly Increase the chances that your intervention will achieve its intended outcomes Build trust, relationships, and collaboration that can support future community efforts These are all excellent reasons to proceed, if the conditions are right. When should you adapt interventions to fit different cultures and communities? Here are six useful criteria: When you think you have a promising idea or intervention When the intervention has been tested or otherwise has evidence suggesting that it can be effective When you are interested in using the intervention in a different community or cultural setting When you have the needed time, funding, people, partnerships, and other resources to move forward When community members have expressed interest in the intervention or in addressing the issue it is designed to address When community members are willing to collaborate in determining whether and how the intervention should be adapted An Important Question: Does An Intervention Always Need to Be Adapted? No, not every single time. There are certainly cases where little or no adaptation is necessary. For example: A grant-writing specialist was asked to give a grant-writing workshop to a Spanish-speaking community group. The basic principles of grant writing were largely the same, although language access and locally relevant examples still needed to be considered. Another specialist gave a digital skills demonstration to a group of recently arrived immigrants from several countries. Participants wanted to learn specific skills. The basic technical content did not need major cultural adaptation, although the instructor still needed to consider language access, participants' previous experience with technology, accessibility, and the examples used during the training. At other times, cultural and community differences do indeed matter: An HIV prevention organization wanted to provide prevention education in a local Spanish-speaking community. Large public meetings did not work well for many community members, but smaller gatherings in trusted neighborhood settings did. The organization worked with community members to hold charlas, or informal community conversations, in homes and other familiar settings. Adapting the setting and format made the information more accessible and the conversations more comfortable. In another community, organizers learned that participants valued relationship-building and informal conversation before beginning a formal meeting agenda. Rather than assuming that one meeting style would work everywhere, facilitators allowed time for participants to connect with one another before moving into structured discussion. The adaptation reflected what community members themselves said helped them participate effectively. These examples involve cultural differences, but the same principle applies to differences in language, age, disability, geography, organizational culture, socioeconomic circumstances, and many other factors. Our general point is that it's difficult to know in advance how much adaptation will be necessary. Rather than making assumptions, learn from the people involved and be prepared to adapt when doing so improves relevance, access, participation, or effectiveness. Just how should you proceed? The "how-to" heading which follows may be helpful. How should you adapt interventions to fit different cultures and communities? Here is one step-by-step approach you can use as a guide. If you are working within an organization, the same steps will apply to your organization as well. Ask yourself, honestly: "Is the intervention worth adapting?" It may be good; but is it good enough? Is there evidence that it is effective or promising? Is its potential value high enough to justify the effort and resources needed to adapt it? A sincere and thoughtful answer to this question before you start can save a lot of time and trouble later on. Suppose you decide the intervention is worth adapting. Does your organization have the commitment and capacity to do the adaptation well? Successful adaptation takes time, relationships, flexibility, resources, and a willingness to learn. Consider whether you and your organization are prepared to make that commitment. You may decide that adaptation should move forward. But here's another question: What should your role be? Your organization may have useful resources or expertise, but community members may be better positioned to lead or co-lead the adaptation. Sharing leadership can strengthen the intervention and help ensure that decisions reflect community knowledge, priorities, and experience. In some cases, your most useful role may be to provide support, technical assistance, funding, or other resources while community partners take the lead. Check your readiness. If you do have a role, are you ready to approach the work with cultural humility, openness, and a willingness to learn? You might want to ask yourself these questions: What are your own cultural values, assumptions, and experiences? How might they shape the way you understand the community or intervention? What experience do you have working with this community or with communities facing similar circumstances? What lessons can you draw from those experiences, and what assumptions should you avoid carrying into this work? Are you and your organization prepared to listen, share decision-making, respond to feedback, and change your approach when appropriate? Learn about community interest, strengths, resources, and conditions. Readiness is not simply something a community either has or lacks. Instead, consider: Are community members interested in the issue or intervention? What priorities have they identified? What strengths, leadership, relationships, knowledge, organizations, and other resources already exist in the community? What additional resources or supports may be needed? How might your organization's history, identity, reputation, or way of working affect the relationship? What can you do to build trust and accountability? Depending on your answers to these questions, you may be ready to go ahead. If so, make the commitment to approach the adaptation collaboratively and provide the time, relationships, and resources needed to do it well. Set specific objectives for the adapted intervention. What, specifically, do community members and partners want it to accomplish? These may seem like a lot of steps to take and questions to ask before you get started. Perhaps they are. But they needn't take a very long time to accomplish. There is a good reason for considering them at the beginning: successful adaptation depends not only on changing the intervention, but also on examining assumptions, building relationships, understanding the local context, and deciding how leadership and decision-making will be shared. All of these points are especially important when adapting interventions across cultures and communities. If you and your community partners decide that not much adaptation is needed, that's fine. If you decide that the intervention should be changed substantially or should not move forward at all, that's also useful information. Careful thought, collaboration, and preparation at the beginning can prevent wasted effort and strengthen the work that follows. And now you are ready to move into the community-engagement and planning work. The next steps follow: Learn about the community and context, especially if you don't already have strong relationships or knowledge of the community. Learn about relevant history, cultural practices, community strengths, institutions, languages, priorities, previous efforts, and current concerns. Avoid assuming that written research can tell you everything about a community; combine it with direct engagement and lived experience. What kinds of questions should you ask? Where can you begin finding information? Your local library and other reliable sources may provide: Census and demographic data Maps Government documents Local reports, assessments, and statistics Local news sources and archives Research, evaluations, and reports about similar interventions with communities that share relevant characteristics Talk with people in the community. Talk with a variety of people if you can. These people can include: People with relevant lived experience, cultural knowledge, professional expertise, or research experience Trusted community members who understand local relationships, history, strengths, priorities, and concerns. These community connectors can help you understand whom else to involve and how to approach the work respectfully. Who are these people, specifically? They could be: Local government officials and public agency staff Business owners, workers, and other business-sector partners Teachers, educators, or college and university faculty Researchers or evaluators People who have worked on similar issues or with similar communities Community members with lived experience, local knowledge, or trusted relationships, whether or not they hold a formal title Community-based organization staff and service providers Faith and spiritual leaders Local media and communications leaders Note that each of these people can themselves be asked who else should be involved. Talking with others may mean spending time one-on-one. Alternatively, you can also talk with others in a group. Listening sessions, focus groups, advisory groups, and community conversations can allow people to build on one another's perspectives, although some participants may prefer individual conversations. Spend time building relationships in the community, especially if you haven't done so already. Attend public events, visit community organizations and gathering places when invited or appropriate, and take time to learn how people connect with one another. The goal is not simply to observe the community from the outside, but to build respectful relationships and better understand the setting through conversation and participation. When you have learned more about the community and developed relationships, begin discussing the intervention idea with community members and potential partners. The people involved should include those who will be affected by the intervention as well as people with relevant knowledge, relationships, or responsibilities. Rather than presenting a finished plan, invite discussion. You might say, "We've been considering this approach because it has worked in another setting. We'd like to understand whether it could be useful here, what would need to change, and whether there are better approaches we should consider." Be transparent about what is already decided, what is open to change, and what role community members can have in shaping the effort. After you introduce the idea, ask for feedback and listen carefully. Do community members think the intervention addresses an important priority? What parts fit well? What parts don't? What changes should be made? What strengths or resources could the intervention build upon? What should happen next? Feedback should influence actual decisions rather than being requested simply as a formality. If many community members and partners tell you that the intervention has little relevance, does not address their priorities, or is unlikely to work in the proposed form, pay attention. This may not be the right time, place, or approach. A different intervention -- possibly one developed or led by community members themselves -- may be more appropriate. If there is sufficient community interest, then you may be ready to move ahead. The next step is to bring together community members and partners who will help shape and carry out the intervention. Some may be people you have spoken with before, and some should be people who will be directly affected by the intervention. If it's an adolescent pregnancy prevention program, for example, adolescents and young parents should be meaningfully involved alongside health professionals, families, educators, and other relevant partners. In other words, at this stage, you want collaborators. You may want to bring these collaborators together into a working group, advisory group, steering committee, or another structure that fits the community. Whenever possible, people most affected by the issue should have meaningful influence over decisions rather than serving only in an advisory role. At this point, you should begin planning and implementation, just as you would with any other intervention; those same basic procedures apply now as well. Your working group can decide what needs to be changed from the original intervention and what should remain. Together, members can agree upon a course of action, establish timelines, conduct pilot tests when appropriate, identify resources, and divide responsibilities. These steps are common to all interventions, whether or not they are adapted. Some special situations: "What should I do if...?" If conflicts arise? If they do, don't be surprised. Conflict and disagreement are natural, especially when people or organizations do not have a history of working together. Relationships need to be formed, expectations clarified, and trust developed over time. A useful guideline is not to suppress disagreement, but to create conditions in which it can be expressed openly and respectfully. Setting this tone at the beginning may help. Regular check-ins about both progress and the collaboration itself may help as well. Develop shared expectations for dealing with conflict so that disagreement can be addressed constructively rather than allowed to undermine the effort. If people from different cultural backgrounds have difficulty understanding one another? When people or organizations from different cultural backgrounds are working together for the first time, they may have different communication styles, expectations, experiences with institutions, or ways of approaching decisions. Structured opportunities for dialogue, cultural learning, and relationship building may help. Cultural humility is an ongoing process, so the goal should not be to teach participants a fixed set of assumptions about another group, but to strengthen their ability to listen, ask questions, recognize their own assumptions, and work respectfully across differences. If materials need translation? You may have materials in one language that you want to make available in another. Before translating, consider whether relevant materials already exist and have been developed or tested for the language community you hope to reach. Sometimes adapting existing materials will save time; in other situations, creating new materials with community members may produce something more relevant and useful. If you do decide to translate, use qualified translators who understand the subject matter and, when possible, the language varieties and cultural context of the intended audience. Have translated materials reviewed by additional speakers from the community for clarity, meaning, accessibility, and tone. Back-translation or other quality-review methods may also be useful when accuracy is especially important. If the adaptation involves several different cultural groups Suppose you are adapting an intervention not just with one community, but with several different cultural or identity groups at the same time. This may occur in culturally diverse communities or in efforts that cross generations, languages, faith traditions, neighborhoods, or other groups. Look for shared priorities while also recognizing meaningful differences. Communities may share goals such as safe and affordable housing, neighborhood safety, access to health care, or strong educational opportunities for children while having different experiences, barriers, strengths, or preferred strategies. Make sure the groups involved have meaningful opportunities to shape the intervention, ask for feedback throughout the process, and listen to what people say. Many culturally diverse organizations and coalitions have successfully worked in this way. Community efforts that build relationships, trust, shared leadership, and progress across different cultures and identities can strengthen both the intervention itself and the community's capacity to work together in the future. In Summary These two closing statements sum up the key points of this section: First, work from an understanding of the experiences, priorities, strengths, and perspectives of the community involved. Don't assume that an intervention that worked elsewhere will automatically fit. Learn from community members, examine your own assumptions, build relationships, and adapt the intervention collaboratively. This takes cultural humility, flexibility, openness, and patience. Second, even with thoughtful planning and strong collaboration, success is not guaranteed. Resources may be limited, priorities may change, or the intervention may turn out not to be the right fit. But when adaptation is done collaboratively and respectfully, the result can be an intervention that is more relevant, accessible, and responsive to the community. The relationships, trust, and shared learning developed through that process can also strengthen future community efforts. Contributor Eric Wadud Bill Berkowitz Resources Online Resources Chapter 8: Respect for Diversity in the "Introduction to Community Psychology" explains cultural humility as an approach to diversity, the dimensions of diversity, the complexity of identity, and important cultural considerations. Community Science analyzes the effectiveness of cultural adaptation in addressing issues in health disparities among communities Print Resources American Red Cross. (1987). Guidelines for Outreach to Minority Populations. The American National Red Cross. Anner, J. (1995). Working Together: Building Successful Multicultural Movements. The Neighborhood Works, June/July.13-21. Gonzalez, V. (1991). Health Promotion in Diverse Cultural Communities. Palo Alto, CA Health Promotion Resource Center, Stanford Center for Research in Disease Prevention. Homan, M. (1994). Promoting community change: making it happen in the real world. Pacific Grove: CA. Brooks/Cole Publishing Company. Pasick, R., et al.(1996). Similarities and Differences Across Cultures: Questions to Inform a Third Generation for Health Promotion Research. Health Education Quarterly, December. 142-161. Rivera, F. (1992). Community Organizing in A Diverse Society. Neeham Heights, MA. Allyn & Bacon. Sabogal, F., et al. (1996). Printed Health Education Materials for Diverse Communities, Health Education Quarterly, December. 123-41. Singer, M. (1991). AIDS and U.S. Ethnic Minorities: The Crisis and Alternative Anthropological Responses. Hartford, CT. Hispanic Health Council. US Department of Health and Human Services.(1994) Communications: Technical Assistance Bulletins:You can use communications principles to create culturally sensitive and effective prevention materials.
