The complex business of adapting effective interventions to new populations: an urban to rural transfer.

PURPOSE To assess the effectiveness of a relatively unaltered version of a sexual risk reduction intervention previously shown to be effective among urban youth, "Original Focus on Kids" (OFOK), compared with a version modified for West Virginia (WVFOK) and a control condition (training in environmental conservation), in altering protective sexual behaviors and perceptions among rural, Appalachian youth. SUBJECTS Nine hundred ninety-nine youth aged 12 to 16 years from 12 rural counties in West Virginia. METHOD Randomized, controlled, longitudinal trial of a theory-based prevention intervention. Outcomes were self-reported sexual behaviors and perceptions assessed at baseline, 3, 6, and 9 months postintervention. RESULTS Both WVFOK and OFOK positively affected perceptions of abstinence but not behaviors. OFOK significantly enhanced some perceptions of condom use compared with both control youth and WVFOK youth, but again, not behaviors. CONCLUSIONS Overall, neither version was as effective as FOK had been in the original urban setting. The less altered version (OFOK) was more effective, especially with regard to condom-use perceptions, in this new population and cultural setting than the more culturally altered version (WVFOK). In several of the implementation settings, neither version was delivered as intended by the researchers because of logistic issues. Although many of these changes were seemingly minor, such deviations may have significant impact on intervention effect.