inefficacy.132 In addition, most research attention, and thus the most success, has been found for
programs that focus on individual behavior, while few prevention strategies address community
and societal risk.133 While these programs are absolutely one part of the strategy to be used,
changing individual behavior alone is not likely to lead to population-level change. 134
The process of implementation and dissemination must also be considered. Widespread
dissemination and high-quality implementation of these effective programs and policies has not
been achieved.135 As a result, there has been a call for greater attention to research to better
understand how evidence-based interventions can be implemented at scale and translated to
widespread practice in communities.136 Translating effective programs into community settings is
a complicated, long-term process but one of immense practical importance.137 Achieving
sustainable interventions requires careful attention to the implementation process.138 Thus,
understanding the necessary factors that support or impede high-quality implementation is an
existing gap in research that needs to be filled.139
Despite the impressive progress made, considerably more work is required to advance
both the science and practice of prevention. Research is needed to test new approaches, identify
mediating mechanisms of intervention effects, understand factors associated with poor
implementation fidelity and how to surmount them, and determine whether adaptation is
necessary to make prevention programs suitable to different populations.140 In addition, future
research should focus on identifying optimal combination(s) of youth violence prevention
strategies that address multiple risk and protective factors at multiple levels of intervention (i.e.,
individual, relational, community, and societal).141 Such efforts are critical in creating effective
comprehensive prevention strategies that will produce population-level violence reduction.142
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132 See Janet Houser, Evidence-Based Practice in Health Care, in EVIDENCE-BASED PRACTICE: AN IMPLEMENTATION GUIDE FOR
HEALTHCARE ORGANIZATIONS 1, 11–12 (Janet Houser & Kathleen S. Oman eds., 2011), available at
http://sgh.org.sa/Portals/0/Articles/Evidence-based%20Practice%20-
%20An%20Implementation%20Guide%20for%20Healthcare%20Organizations.pdf (discussing barriers to using evidence-based
practices in healthcare settings); IOWA PRACTICE IMPROVEMENT COLLABORATIVE, EVIDENCE-BASED PRACTICES: AN
IMPLEMENTATION GUIDE FOR COMMUNITY BASED SUBSTANCE ABUSE TREATMENT AGENCIES 15–16 (2003), available at
http://www.uiowa.edu/~iowapic/files/EBP%20Guide%20-%20Revised%205-03.pdf (discussing individual and organizational
demands that impede adoption and implementation of evidence-based programs and practices in community agencies).
133 World Health Org., supra note 63, at 43–45.
134 Id. at 47–48.
135 Delbert S. Elliott & Sharon Mihalic, Issues in Disseminating and Replicating Effective Prevention Programs, 5 PREVENTION SCI.
47, 47 (2004).
136 Id.
137 Id. at 48.
138 See id. at 47–50.
139 Id. at 48.
140 Id. at 47–48. There has been an ongoing debate about whether or not evidence-based programs should be implemented as intended
by the program developer or modified to align with the local context of the implementing site. Id. at 50. Although there is an
increasing demand for local adaptations of evidence-based prevention programs, there is a lack of rigorous research examining the
impact of such modifications on program effectiveness. Id. at 51; see also Ecological Effects, supra note 106, at 540 (need explanatory
parenthetical for see also cite).
141 WORLD HEALTH ORG., supra note 63, at 46–47.
