Getting to Outcomes Step 04. Fit
This step provides a structure to determine whether the program you identified during GTO Step 3 is appropriate for your target, community, and organization.
What Is This Step?
Fit means that you have a good and close match between the selected or potential approach or program and your own:
-
Target population and their needs: For example, if your target population is Spanish-speaking older adults, is the program you are considering intended for older adults who speak Spanish?
- Community: For example, if the program you are considering emphasizes stockpiling supplies in a high-poverty community or uses a hurricane-based scenario in a community whose greatest risk is earthquakes, will the community be supportive enough?
- Organization: For example, does the program you are considering fit your organization’s values? Mission? Schedule?
GTO Step 4 helps you evaluate the extent to which each program you are considering is appropriate (i.e., a fit) for your target population, community, and your organization. In this step, you will consider such things as culture, values and practices, organizational mission, and existing programs within the community. The purpose of assessing fit is to either avoid programs that do not fit well or improve fit by making acceptable adaptations. This step can help you narrow down your choices from the possible options you identified in Step 3.
Once you have selected a program, a key feature of GTO Step 4 is making changes to improve its fit, often called adaptation. These changes need to be made very carefully. Change the program too much, and you may not get the outcomes that the program has achieved before.
Why Is This Step Important?
You want to use the best program you can offer. Programs that do not fit your target population, organization, or community well are likely to face implementation challenges and, therefore, are less likely to achieve the desired outcomes. Assessing fit before using a program is important for several reasons:
- It increases the chances that a program will be accepted by and will be good for the target population.
- It helps avoid duplication of efforts (do not start a program that overlaps with an existing one).
- It helps avoid finding out later that the program failed because it was a mismatch (a poor fit) with your target population, your community, and/or your organization.
- When there are fit problems that cannot be resolved, a program should not be used.
- The fit assessment helps when selecting from several candidate programs (choose the one with the best fit).
How Do I Carry Out This Step?
To assess the fit of the programs you are considering, use the GTO Step 4 tool:
- The Program Fit Assessment Tool will prompt you to consider how the candidate programs identified in Step 3 fit with your target population, organization, and stakeholders.
As you complete this tool, you will want to decide what adaptations, if any, to make to improve the fit of the candidate program or programs still under consideration.
Tip 4.1. Types of program adaptations
Red-light adaptations, such as reducing or eliminating major activities or topics, may greatly weaken the program and generally would not be advised. For example, programs often provide opportunities to practice new skills as a critical step in changing behavior. Reducing or eliminating practice components may make the program less effective.
Yellow-light adaptations are more complex and may alter program content, so you should proceed with greater caution. They often require expert assistance from the program developer or someone experienced with using the program—e.g., the LHD trainer in Townville—to avoid weakening the content of the program.
Green-light adaptations are considered safe, easy changes that can make a program better connect with the audience (i.e., to fit the program to the culture and context). These adaptations do not change the core topics addressed by the program. They are generally minor changes, such as adjusting the location to one familiar to the participants. Tailoring minor elements to better reflect the target population can improve most programs, and you should feel comfortable making such adjustments. In sum, green-light adaptations do not change what makes a program effective (i.e., the core components).
Tip 4-2. Examples of program adaptations
Red-Light Adaptations
- Shortening a program (e.g., deleting an activity or whole session)
- Reducing or eliminating activities that allow participants to personalize risk material
- Reducing or eliminating opportunities for skill practice
- Eliminating a focus on certain topics
- Contradicting, competing with, or diluting program goals
- Replacing interactive activities with lectures or individual work
Yellow-Light Adaptations
- Changing the order of sessions or sequence of activities
- Adding activities to reinforce learning
- Adding activities to address additional topics
- Replacing or supplementing videos (with other videos or activities)
- Using other models or tools that teach the same skill
- Implementing the program with a population (e.g., ethnic or cultural group) for which there is less evidence
- Replacing activities
Green-Light Adaptations
- Updating and/or customizing statistics and other information
- Adjusting the location of the program to one familiar and convenient for participants
- Adding debriefing or processing questions
- Making activities more interactive, appealing to different learning styles
- Customizing written documents (e.g., the use of wording more reflective of program participants served)
Tools Used in This Step
Program Fit Assessment Tool
Instructions
- Make as many copies of the tool as necessary for you and your co-workers to complete this tool for each of the remaining programs you are considering.
- Starting with row 1 (target population needs), work through the questions in the fit tool, laying out the program considerations and requirements and answering yes or no in the appropriate columns. You may need to talk to several different people to get the answers (e.g., members of target group, colleagues, co-workers).
- If no adaptations are needed, you can do the program as is. If adaptations are needed, enter your ideas in the column labeled, “What adaptations can be made to increase the fit?”
- If adaptations are needed, figure out whether they are green-light, yellow-light, or red-light adaptations. Definitions of each type of adaptation are provided in Tip 4.1, and examples of each type are listed in Tip 4.2.
Example
- Completed by: Project team/coordinator
- Date: January
- Program Being Considered: ROAD-MAP
| Demographic | Consideration Type | Considerations | Fits? Yes/No | What adaptations can be made to increase the fit? |
|---|---|---|---|---|
| Fit with the target population’s… | 1. Needs | Program must improve medical preparedness and household preparedness specifically for older adults, many of whom have chronic health issues or cognitive impairments | Yes | None needed |
| 2. Demographic characteristics |
Program must be accessible to:
|
Some work needed |
|
|
|
3. Other: Cognitive/visual abilities |
Use of large fonts, spacing, and visuals to enhance comprehension | Yes | None needed | |
| Fit with the community’s … | 4. Cultural norms | Curriculum should be relevant to people with different cultural norms—e.g., using the names of food types familiar to participants at each of the senior centers | Yes | Adapt names of food types in curriculum to those familiar to each of the cultural groups who attend the different senior centers |
| 5. Environment | Program has to be accessible to older adults living in neighborhoods served by senior centers with transportation to and from the centers—e.g., during daytime hours | Yes | None needed | |
| 6. Other: _ | Use of large fonts, spacing, and visuals to enhance comprehension | Yes | None needed | |
| Fit with your organization’s … | 7. Mission | “Improve the quality of life for our residents by promoting a safe and healthy community in which to live, work and play” | Yes | None needed |
| 8. Priorities | Prepare city residents to respond to disasters, collaborate with community organizations to enhance preparedness | Yes | None needed | |
| 9. Leadership support | LHD officers must support project and use of staff time to plan, implement, and evaluate the program | Yes | None needed | |
| 10. Context/setting | LHD staff must have time and support to deliver the program in the community | Yes | None needed | |
| 11. Readiness for intervention | Implementation within next six months | Some work needed | Need to work with busy schedule to find time to implement this program while carrying out other work duties | |
| 12. Other: |
Step Checklist
When you finish working on this step, you should have:
- Completed the Step 4 tools for all programs under consideration
- Developed an understanding of what fit means
- Considered the most important aspects of your program to make sure there is a good fit with your target population, your organization, and your community
- Determined the right adaptation needed, if any, to improve the fit of your program(s)
- Further narrowed your choice of programs to implement
Before Moving On
After reviewing your potential programs with fit in mind, you might have a clearer idea which programs that you selected in Step 3 are still good possibilities. If there are candidate programs that would have to be drastically adapted to fit, then you may way to eliminate them before going on to Step 5. If none of the potential programs have passed the ‘fit’ test you conducted here in Step 4, you may need to go back to Step 3 and do some more investigation to find a new set of programs to consider. Knowing more about fit now may also help you more quickly zero in on potential programs if you do circle back to Step 3 for more investigation.
In Step 5, we’ll show you how to examine the current capacities of the lead agency/organization/partners to make sure it can do a good job in implementing the selected program. Step 5 will be the final reviewing step before moving onto planning and implementing the selected program as well as establishing evaluation criteria.