Facilitator suggestions to increase cultural relevance of an evidence-based intervention: A qualitative analysis

Background . Once an intervention is deemed “evidence-based,” it is often disseminated across contexts, settings, and populations beyond those originally tested. The cultural relevance or “fit” of an evidence-based intervention (EBI) in diverse local contexts is a debated topic, but few studies have explored facilitators' perceptions. This study examines facilitators' suggestions for improving the cultural relevance of a universal preventive EBI widely disseminated in middle schools for over 30 years. Method . Using process evaluation data from a dissemination project (2019-2022) in 363 schools across 16 US states, 566 open-ended responses from EBI facilitators were analyzed using the Framework Method (i.e., a content analysis approach). Results . Five broad themes emerged among 758 unique suggestions: 1) social or technological relevance (52% of codes), 2) teacher or school-related considerations (13% of codes), 3) student engagement (10% of codes), 4) adaptations for diverse students (9% of codes), and 5) curriculum mechanics (4% of codes). Facilitators overwhelmingly suggested improving cultural relevance by updating social and technological aspects to reflect current trends in substance use, youth culture, and implementation. Discussion . The study underscores a component of cultural relevance that is particularly relevant to on-the-ground implementers. Feasible ways for EBIs to stay current on social trends and technology to reflect evolving trends in risk behaviors, youth culture, and implementation are essential to increase or maintain the cultural relevance of an EBI. Addressing these areas is crucial for enhancing the long-term adoption, fidelity, and effectiveness of EBIs across diverse populations and evolving cultural landscapes.