From innovation to implementation: the long and winding road.

Building on theory and past research, in early 2000 scientists in the Division of Reproductive Health developed a prevention innovation for CDC's Global AIDS Program for use in countries severely affected by the HIV/AIDS epidemic. This innovative program model is called MARCH: Modeling and Reinforcement to Combat HIV/AIDS (Galavotti et al. Am J Public Health 91:1602-1607, 2001). MARCH promotes behavioral changes that reduce the risk of HIV infection and creates normative environments that sustain these changes through two key program components: entertainment-education using mass media, particularly long-running radio serial dramas, and reinforcement activities at the community level. Using the framework developed by Wandersman et al. (Am J Commun Psychol, 41(3-4), 2008), we describe the key elements of the MARCH prevention innovation and outline how we support its adaptation and implementation. We focus on the following questions: How do we get from an innovative model to effective program implementation in the field? How do we support implementation with fidelity when adaptation is required? And, once implemented, can we demonstrate fidelity of the adaptation to the original program model? Because our program model requires local adaptation for every instance of implementation, we suggest a potential enhancement to the Interactive Systems Framework-support for adaptation of the innovation-as part of the Prevention Support System. In this paper we describe how we supported adaptation of the radio serial drama component for unique contexts in several African countries. We focus attention on the tools and trainings we developed to build innovation specific capacity for implementation, including capacities for adaptation. We then present results of a qualitative analysis of scripts from the MARCH radio serial drama in Zimbabwe to assess the adapted program's fidelity to the original design of the innovation. Finally, we discuss lessons learned and explore implications for the field.

Applying behavioral science to behavior change communication: the pathways to change tools.

Entertainment-education (EE) is a popular vehicle for behavior change communication (BCC) in many areas of public health, especially in the developing world where soap operas and other serial drama formats play a central role in encouraging people to avoid risky behavior. Yet BCC/EE developers have been largely unable to integrate behavioral theory and research systematically into storylines and scripts, depending instead on external, technical oversight of what should be an essentially local, creative process. This article describes how the Modeling and Reinforcement to Combat HIV/AIDS project at the Centers for Disease Control and Prevention has developed a set of tools through which creative writers can exercise greater control over the behavioral content of their stories. The Pathways to Change tools both guide scriptwriters as they write BCC/EE storylines and help project managers monitor BCC/EE products for theoretical fidelity and sensitivity to research.