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Authors: Alexandria Scarlett (University of Miami), Angie Gaitan, Claudia Bonilla (University of Miami), Eric C. Brown (University of Miami), Filip Bogdan Serban Dragan (University of Miami), Leslie Leve (University of Oregon), Veronica Paley (University of Miami)
Introduction: Communities That Care (CTC) is an evidence-based community prevention system for the prevention of youth drug use that has been adapted and is being used in several countries around the world. Although an upper-middle income country, Romania is at a nascent stage of prevention science development, and the implementation of CTC in an eastern European (Balkan) country may present unique challenges not experienced in other countries. To address this, our study presents an evolving qualitative research inquiry into the potential cultural adaptation of CTC for use in Romania. Through qualitative interviews with experts who have extensive field experience implementing CTC in culturally diverse regions around the world we provide insights into a potential Romanian adaptation of CTC.
Methods: To date, we conducted 14 qualitative interviews with CTC experts (i.e., key informants) who have practical experience adapting the CTC system to local national cultures (e.g., in Brazil, Chile, Germany, Colombia, Sweden, and the U.S.). Five of these interviews were analyzed using thematic analysis. A second round of interviews is currently underway with additional key informants and questions to expand the respondent pool, validate derived themes and add new insights. Questions in the interview guide explored specific characteristics and strategies of CTC community coalitions and adjustments made to the CTC system for cultural relevance. Thematic analysis was conducted using between two and five independent coders to systematically identify and synthesize themes from the interviews.
Results: Results of the thematic analysis revealed three major themes that inform the cultural adaptation and implementation of the CTC framework. First, community characteristics play a crucial role in successful implementation. Participants emphasized the importance of community readiness, stakeholder characteristics, and capacity-building efforts. Most described community readiness as neutral or negative, underscoring the need for early engagement and local ownership in the preparatory phases of implementation. Second, while CTC’s core principles provide a strong foundation, successful adaptation requires modification of system components to align with local norms, languages, and organizational structures. Experts stressed that flexibility and responsiveness to context are key, warning that overly rigid application of the model could compromise its effectiveness. Finally, collaborative efforts emerged as central to both adaptation and sustainability. Participants highlighted how systemic barriers—such as limited resources, infrastructure inequities, and political instability—can hinder progress. However, community partnerships, continued stakeholder engagement, and technical assistance from prevention scientists were described as critical strategies for overcoming these barriers and fostering shared responsibility.
Conclusion: This study demonstrates the importance of context-sensitive approaches in adapting prevention system frameworks like CTC to countries (e.g., Romania) that are just beginning to use these frameworks. By incorporating insights from experts with extensive international experience, the findings contribute to a more robust understanding of the practical considerations needed for effective cultural adaptation. This evolving research inquiry thus contributes a critical understanding of how CTC can be both culturally adaptable and effective, enhancing its potential to address pressing prevention needs within Romanian and other diverse cultural landscapes.
| Conflict of interest | no conflicts to declare |
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