Table 1.

Adaptation “to do list” for telephone counseling program.

Breast Cancer Screening Among Nonadherent Women
Fit category	Adaptation ideas
Behaviors from logic model of change   Adherence to mammography	Change behavior to “appointment keeping” rather than general mammogram
Environmental conditions from logic model of change	No change
Change methods (with determinants) for at risk group:   Information dissemination (barriers)  Staging (but does not seem closely related to change methods beyond information)	Role modeling: quotations from women in the community regarding barriers  Problem solving: regarding logistical barriers  Information dissemination: correcting misinformation  Persuasion: by culturally congruent navigator   Message matching to stage of change: initial message to either preparation/action or precontemplation/contemplation
Change methods (with determinants) for environmental agents	Not applicable
Delivery for components, at risk group:  Telephone counseling call. Note: does not have conversational structure comfortable for navigators to implement	Change staging question and scripts to be less research oriented and more “real-world” navigator approach  Develop an active listening framework for barrier scripts   Retain staging but with only two classifications (precontemplation/contemplation; preparation/action)  Editing for local idiom (ways of speaking of breast cancer and barriers)
List delivery for components, environmental agents	Not applicable
List design features and cultural relevance  Barriers are general and information-based	Add barriers described by local women: perceived likelihood of no cancer; expectation that God will protect against cancer; no money for treatment; becoming less than a woman with the loss of a breast; fear of losing partner; cancer being a death sentence; time only for caring for others Logistics: no time off work; no transportation; responsibilities caring for a child or others; money/lack of awareness of programs that can pay for breast cancer treatment
Describe implementation plan  Research-based; elaborate staging; unclear how script changes based on staging; unclear transition between one barrier and the next	Add script with conversational transitions  Add local barriers  Simplify stages  Match script to stage