For many years, program designers and practitioners within the social sector, particularly in health promotion and disease preventions fields, have investigated different methods that would effectively diffuse prevention programs with vital information to target populations. It was hoped that the diffusion of these programs, many of which are publicly funded, would result in overall better health and the absence of preventable diseases. Despite the time and effort devoted to this task, it remains challenging to determine the most appropriate methods that will ensure that a program is implemented with fidelity, as originally designed. Research indicates that as programs are diffused throughout different locations or communities these sites often modify or "re-invent" various program components as compared to the original program model. What is often variable is the identification of which factors influence the implementers' decisions to modify or re-invent the program and which types of re-inventions actually occur. Research to date has identified several possible factors including those related to the characteristics of the innovation or program itself, the personality of the facilitator, and the impact of the organization. This study examines the relationship between organizational factors that influence implementation of a prevention program and the degree and type of re-invention. The study poses research questions about the impact of several organizational factors on re-invention including: characteristics of the organization, organizational culture, support from leadership, resource availability, and interaction with community partners. The population studied includes 59 community sites that implement an injury prevention program related to risk-taking behaviors and targeted toward students between the ages of 14-19 years. Measures used include the administration of two questionnaires and a semi-structured telephone interview. The first instrument gathered information about the organizational factors that might influence implementation of the program, and the second instrument gathered information about how these sites re-invented the injury prevention program. This second instrument is used to determine the degree of re-invention (based on a calculated re-invention score), as well as the types of re-invention that occur. Data analysis included correlations between organizational factors and the degree of re-invention. Study results indicate some significant results between type of organization and re-invention score, as well as negative correlations between re-invention scores and two areas: number of community partners involved, and adequate number of people consistently involved in the program. There were no significant results related to organizational culture and support from leadership. Most common types of re-invention were modifications to program sequence and content, though most re-invention types were evenly distributed. Telephone interviews conducted with the top ten re-inventing sites indicate availability of resources, perceived need to increase interactivity, and logistics as the primary reasons for re-inventing components of the injury prevention program. These and other findings are discussed as well as implications for designers, practitioners, and funders. Limitations related to the study and recommendations for future research are also presented.
