Table 4.

Characteristics of the adaptations (k = 42)

First author, year	Adaptation type1					Specific modifications			Adaptation steps2										Evaluation outcomes (k = 36)	Modification/adaptation example
	1	2	3	4	5	Content	Context	Delivery	1	2	3	4	5	6	7	8	9	10
Reijneveld, 2003 [53]	x	x	x	x	x	Tailoring Adding elements Lengthening Substitution Cultural modification	Population	Deliverer Other	x	x		x	x	x	x	x	x		Acceptability Fidelity	Examples regarding safety excluded cycling because few Turkish immigrants cycle
Komro, 2004 [54]	x	x	x			Tailoring Adding elements Cultural modification	Setting Population	Mode/medium Deliverer	x	x	x	x	x	x	x	x			Acceptability Fidelity	Audiotape vignettes re-taped with African American and Hispanic actors
Sarkisian, 2005 [55]	x		x			Tailoring Adding elements Lengthening Cultural modification	Setting Population	–	x		x		x						Acceptability	Expanded focus to more explicitly include family members
Tsey, 2005 [56]	x	x	x			Tailoring Shortening Loosening structure	Setting Population	Mode/medium Deliverer	x							x	x		Acceptability Adoption Sustainability Individual satisfaction	Students interviewed their role models, explaining why they looked up to that person
Villarruel, 2005 [58]	x	x		x	x	Tailoring Adding elements Cultural modification	Population	–	x	x	x	x	x	x	x	x	x		Acceptability Individual satisfaction	Presented the view of machismo that incorporated the values of caring for and protecting others, so condom use could be presented as consistent with machismo
Belanksy, 2006 [59]	x	x		x	x	Tailoring Adding elements Shortening Cultural modification	Setting Population	–	x		x	x	x	x	x	x	x		–	Lessons simplified so that they could be completed during the 1-h classroom period
Hitt, 2006 [60]	x	x		x		Tailoring Loosening structure	Setting Population	–	x	x	x	x	x	x		x	x		Acceptability Adoption Fidelity Feasibility Sustainability Individual satisfaction	Intervention protocols and supporting materials (tools) were tailored for local circumstances
Somerville, 2006 [62]	x	x		x	x	Tailoring Adding elements Substitution Integrating other approach Cultural modification	Setting Population	–	x	x	x	x	x	x	x	x	x		Acceptability Fidelity Other Individual satisfaction	A variety of successful Latino-focused HIV prevention training programs were integrated into the adapted intervention
NIMH Collaborative HIV/STD Prevention Trial Group, 2007 [38]	x	x		x	x	Tailoring Cultural modification	Other	–	x	x	x	x	x	x	x	x	x	x	Adoption Fidelity Feasibility Sustainability	Specific messages used in training were based on findings that emerged from the ethnography with each site’s populations
Tsarouk, 2007 [63]	x	x				Tailoring Removing elements Shortening Substitution Cultural modification	Other	–	x		x		x	x	x		x		Acceptability Feasibility Individual satisfaction	Some of the support behaviors, such as applauding in response to a group member’s participation, were removed because teens said that it is not a natural expression of support in this informal situation
Beattie, 2008 [64]	x	x			x	Tailoring Removing elements Shortening Integrating other approach Cultural modification	Setting Population	–	x		x	x	x			x	x		Acceptability Adoption Sustainability	Some sites used a swim camp model, with several days of training provided often on two or three occasions and typically at a central point for families traveling long distances
Cornelius, 2008 [28]	x	x				Tailoring Adding elements Removing elements Lengthening Substitution	Setting Population	–	x	x				x					–	Used videos that included information about HIV in older women
Gitlin, 2008 [30]	x	x	x			Tailoring Adding elements Cultural modification	Setting Population	–	x		x	x		x		x	x		Acceptability Adoption Fidelity Feasibility Sustainability Other Individual satisfaction	Introduction of moment of silence at the beginning of each session to recognize spiritual practices and their importance to participants
Lerdboon, 2008 [67]	x	x				Tailoring Adding elements Integrating other approach Cultural modification	Setting	–	x	x	x	x	x	x	x	x	x		Acceptability Adoption Feasibility	Gender-specific components were integrated throughout the curriculum through a story line about an adolescent boy and girl growing up in a fictional Vietnamese family, as well as gender-specific scenarios, activities and messages
Steiker, 2008 [29]	x	x				Tailoring Adding elements Cultural modification	Setting Population	–	x		x		x	x	x	x	x		Acceptability Adoption Fidelity	Created four new videos, one for each prevention strategy: refuse, explain, avoid and leave
Burgio, 2009 [68]	x	x	x	x	x	Tailoring Removing elements Shortening	Setting Population	Mode/medium Deliverer	x		x	x	x	x		x	x		Acceptability Adoption Fidelity Feasibility Individual satisfaction	Reduced number of home visits and shortened time span of the intervention
Fiscian, 2009 [69]	x	x	x		x	Tailoring Adding elements Removing elements Lengthening Reorder elements Integrating other approach Cultural modification	Setting Population	Mode/medium	x		x	x	x	x		x	x		Acceptability Fidelity Individual satisfaction	Modified role-play stories to use African names and settings and simplified scripts to a sixth-grade reading level
Mueller, 2009 [31]	x	x				Adding elements Lengthening Substitution Loosening structure	Setting	–	x		x	x	x	x		x			Acceptability Feasibility Sustainability Individual satisfaction	Adapted from community agency or after-school programs to be integrated into existing school curriculum
Pekmezi, 2009 [70]	x	x			x	Tailoring Cultural modification	Population	–	x		x			x	x	x	x		Acceptability Feasibility Individual satisfaction	Intervention materials and research measures were translated into Spanish through an iterative process involving both translation and back-translation
Stevens, 2009 [71]	x	x	x		x	Tailoring Adding elements	–	Deliverer		x	x	x	x	x		x	x		Fidelity	Support teams for caregivers were created
DePue, 2010 [72]	x	x	x	x	x	Tailoring Adding elements Loosening structure Cultural modification	Setting Population	Mode/medium Deliverer	x	x	x	x	x	x	x	x	x		Adoption Feasibility	Incorporated local cultural features in flipcharts, including quotes from focus groups, culturally relevant examples of healthy behaviors, local sources of stress, and effective local coping strategies
Domenech Rodriguez, 2011 [73]	x	x	x			Tailoring Adding elements Loosening structure Cultural modification	Setting Population	Deliverer	x	x	x	x	x	x	x	x	x		Acceptability Fidelity Feasibility Individual satisfaction	Sayings, or dichos, were incorporated generously into treatment manual as parents used them during the parent training sessions
Poulsen, 2010 [39] Vandenhoubt, 2010 [75]	x	x	x			Tailoring Adding elements Substitution Cultural modification	Setting Population Other	Mode/medium Deliverer	x	x	x	x	x	x	x	x	x	x	Acceptability Adoption Fidelity Sustainability Individual satisfaction	Owing to low literacy rates among local adults, drawings were used to illustrate messages that were originally conveyed through text on posters and handouts
Sadler, 2010 [76]	x					Tailoring Adding elements Shortening Reorder elements Cultural modification	Population	Deliverer	x					x	x				–	PowerPoint voice over changed to be in the first person instead of third to inspire comradery and motivation for women battling cancer together through clinical trials
Rotheram-Borus, 2011 [77]	x	x	x			Tailoring Adding elements Removing elements Shortening Substitution Integrating intervention Repeating elements Cultural modification	Setting Population	Mode/medium Deliverer	x					x	x	x	x		Other	The intervention content and framing was adapted to resonate with Buddhist values and idioms around “sound body and sound mind”, as well as Thai values around the importance of family and community in health and well-being
Cardona, 2009 [78]	x	x	x			Tailoring Adding elements Loosening structure Cultural modification	Setting Population	Other	x	x	x	x	x	x		x	x		Acceptability Adoption Fidelity Feasibility Individual satisfaction	Substituted a booster session with a session on “Parenting between two cultures” to add relevance to Latino immigrant families
Feinberg, 2012 [79]	x	x	x	x		Tailoring Removing elements Integrating intervention Cultural modification	Setting Population	Mode/medium Deliverer Other	x	x	x	x	x	x	x	x			Acceptability Fidelity Feasibility Individual satisfaction	Reframed the focus of the intervention from prevention of depression to learning new skills to deal with everyday stress, with an emphasis on parenting
Parker, 2012 [81] Chen, 2013 [82]	x	x	x			Tailoring Adding elements Removing elements Lengthening Reorder elements Cultural modification	Population	Mode/medium	x	x	x		x	x					Acceptability Adoption Fidelity Feasibility	Created “action plan for sustainability” to link participants with exercise/disease self-management programs in neighborhood
Reid, 2012 [83]	x	x				Tailoring Adding elements Departing Cultural modification	Setting Population	Other	x		x	x	x	x	x	x			Acceptability Adoption Fidelity Feasibility Individual satisfaction	Sociocultural norms, values, beliefs, and myths were applied to role-play scenarios and exercises
Rosati, 2012 [84]	x	x				Tailoring Adding elements Loosening structure Cultural modification	Setting	Mode/medium	x	x		x		x		x	x		Acceptability Adoption Fidelity Feasibility Individual satisfaction	Added a unit targeting adolescent dating and sexual behavior after conducting focus groups with Thai parents
Tomioka, 2012 [85]	x	x		x	x	Tailoring Adding elements Lengthening Cultural modification	Population	–	x	x	x	x		x		x	x		Acceptability Adoption Fidelity Feasibility Sustainability Individual satisfaction	Added opening session with a prayer, a 6-month reunion, and provided certificate of completion
Danielson, 2013 [33]	x	x	x		x	Tailoring Shortening Loosening structure Departing	Setting Population	Mode/medium					x	x		x	x		Adoption Fidelity Feasibility Other Individual satisfaction	Used a web-based delivery platform instead of small group sessions with 10–12 girls
Fasula, 2013 [86]	x	x	x	x		Tailoring Adding elements Shortening Lengthening Loosening structure Cultural modification	Setting Population	Deliverer	x	x	x	x	x	x	x				–	Several intervention elements were added to increase participants’ risk awareness, knowledge, and skills related to substance use, including a group discussion about the pros and cons of substance use, how drugs/alcohol contribute to sexual risk, and strategies for avoiding risk
Parker, 2013a [88] Parker, 2013b [89]	x	x	x			Tailoring Adding elements Removing elements Shortening Integrating other approach Cultural modification	Setting Population	Mode/medium	x	x	x	x		x	x	x	x		Acceptability Feasibility	Changed delivery from individual to group so there was peer reinforcement content
Wainer, 2013 [90]	x	x	x	x	x	Shortening Loosening structure	Setting	Mode/medium				x		x	x		x		Acceptability Fidelity Feasibility	Therapists completed the online training program on computers in their homes or in the research lab
Williams, 2013 [91]	x	x	x	x		Tailoring Adding elements Cultural modification	Setting Population	Deliverer	x	x	x	x	x		x	x			Adoption	The culturally adapted intervention took a more deliberate and structured approach to including the family in discussion and planning
Baydala,2014 [92]	x	x			x	Tailoring Adding elements Lengthening Cultural modification	Population	–	x	x	x	x	x	x	x	x	x		Acceptability Adoption Fidelity Feasibility Sustainability	Elders suggested inclusion of lessons that embraced Aboriginal spirituality, such as an activity on healing the worried mind where students were encouraged to take their worried mind to Waka (God/Creator) and engage in wacigebi (prayer)
Broning, 2014 [93]	x	x				Tailoring Cultural modification	Population	–				x			x	x	x		–	Intervention was translated and adapted to German culture, taking into account family-based interventions are especially culture-sensitive regarding role-model behavior, values and norms
Cariou, 2014 [94]	x	x		x	x	Tailoring Adding elements Removing elements	Setting Population	–	x	x	x	x	x	x		x	x	x	Adoption Sustainability Other	Eliminated optional poolside activities and retained the few that were feasible based on available resources
Reback, 2014 [96]	x	x	x	x	x	Tailoring Adding elements Removing elements Shortening Reorder elements Cultural modification	Setting	Deliverer	x		x	x	x	x		x	x		Adoption Feasibility Sustainability	Gay-specific cultural references were updated to maintain cultural relevancy (i.e., exchanging references to telephone dating lines with references to social networking web sites)
Riggs, 2014 [32]	x		x		x	Adding elements Shortening	–	Mode/medium Deliverer	x	x			x	x	x	x	x		Acceptability Fidelity Feasibility	Masters-level research interventionists delivered treatment rather than medical staff
Tu, 2014 [98]	x	x	x	x	x	Tailoring Removing elements	Population	Deliverer				x		x		x	x		–	In-person education from health educator was deleted

¹Adaptation type: (1) content, (2) context, (3) delivery, (4) training, and (5) evaluation

²Adaptation steps: (1) community assessment, (2) selection, (3) determine level of change, (4) train staff, (5) consult stakeholders/experts, (6) prepare materials, (7) pilot, (8) implement, (9) evaluate, and (10) other