TABLE 3.

RESET Tool Example 1

Relevance: Is this health promotion topic relevant to the target population?
• Is the topic of sufficient concern that action is required?	The population did not view chewing paan as a health risk; in fact, it was often viewed as health enhancing, and so considerable work would be required for promotion, engagement, and recruitment to raise awareness of the health risks.
• Are there competing priorities for this population that would lessen their engagement with this intervention?	Women were the target population, and competing priorities were their family obligations and concerns, which left little time for them to consider and take care of their own health.
Evidence base: What is the best intervention to address this health topic in this population?
• Is there evidence of an intervention effect in the general population?	There is evidence of the effect of using NRT for smoking cessation in both the general and the target population, but limited evidence for its use for the cessation of chewing tobacco/paan.
• Is there evidence of an intervention effect in the target population?
Stage of intervention: What stage(s) of the intervention should be adapted?
• What stages need adaptation for this population? (Adaptation may not be needed at every stage; e.g., English is appropriate as the language of intervention delivery for African Americans.)	All stages of this intervention need adaptation, if possible.
• What stages can be adapted in this intervention? (Little adaptation can be undertaken with pharmacotherapy, e.g., nicotine replacement therapy.)	There is little adaptation that can be undertaken for the use of NRT, but all the other stages can be adapted.
• What stages should be prioritized for adaptation? (There may not be resources available to undertake all desired adaptations, so adaptations require prioritization.)	There was not enough capacity to provide ethnically appropriate intervention staff in all positions, so ethnic matching was prioritized for the staff undertaking the intervention delivery.
Ethnicity: What elements of ethnicity are most important to consider for this population?
• What are the conventional elements important to consider in adaptation (e.g., religion, language, culture, physical features, ancestry, age, gender, and socioeconomic status)?	It was important to adapt for religion, language, culture, age, and socioeconomic status.
• What are the contextual elements important to consider in adaptation (social environments, physical space, past exposures to health research and services, and diverse life experiences, including stress)?	It was particularly important to adapt for social environments, as the chewing of paan is a significant social practice, so the intervention needed to offer replacement social opportunities.
• What is the target population's degree of heterogeneity, and is it possible to assess heterogeneity (i.e., measure ethnic identity, cultural affiliation, or acculturation) and to adapt the intervention appropriately at a subgroup level?	The population's heterogeneity was assessed, and the priority population (in terms of tobacco use) was determined to be the older generation. Therefore the intervention was adapted accordingly (to determine factors such as language use and intervention setting).
Trends: What are the shifting trends in this population?
• Are there shifting patterns and trends in behaviors in this population?	There appears to be a shifting trend in which more young Bangladeshi women are chewing paan with tobacco. This trend needs monitoring and the intervention adapted to include the needs of this younger population.
• Can we monitor the patterns and trends in population characteristics, preferences, and contexts and revise the adaptation(s) to maintain relevancy over time?

Note: This example demonstrates the use of the RESET tool to guide the adaptation of a tobacco cessation intervention for Bangladeshi women in the Tower Hamlets area of London and outlines some of the contextual considerations that may guide the intervention.