Table 1.

Application of the Assessment, Decision, Adaptation, Production, Topical experts—Integration, Training, Testing framework with a preventive maintenance intervention texting adaptation in Afiya.

Phase			Methodology decisions		Results or observations
1. Assessment			Formed advisory board Conducted an initial meeting with advisory board Conducted meetings with intervention experts for the target population		The target population (African American adolescent females) requires interventions addressing their specific situation The intervention needs to address safer sex norms, sexual negotiation, and refusal skills, HIV and STIa preventive attitudes The advisory board was selected for project, met, and provided input on the plan Advisory board members were paid as consultants to develop or test the feasibility of texting PMIb
2. Decision			Selected HORIZONS and Afiya interventions Decided to adapt Afiya phone-based PMIs to texting PMIs Original developer of Afiya-led adaptation mHealthc and texting literature reviewed		HORIZONS, an evidence-based intervention that successfully reduced STIs and increased condom use among young women, was selected as it appropriately addressed the target population Afiya selected as it demonstrated a PMI based on HORIZONS to the same target population, but extend the efficacy of the HORIZONS intervention Texting is most likely the simplest mHealth adaptation to adapt from Afiya and appropriate implementation technology choice for the target population
3. Administration			Decided not to modify Afiya core elements Decided to focus on Afiya core element support by texts Adaptation would involve scripts and texts responses based on Afiya documents and data		Retention of primary intervention form assured standard of care and served as a shared primary intervention control (therefore, theater testing was not conducted) 5 core elements of Afiya were identified to be supported by PMIs
4. Production			Designed 8-week iterative formative pilot plan for adaptation Designed questionnaires and focus group–led questions Designed initial texts and support scripts Selected company for formative pilot texting Reviewed with Afiya and HORIZONS creators Reviewed plan with advisory board Assembled Afiya workshop materials		Iterative formative pilot designed for advisory board Primary intervention led by Afiya and HORIZONS developers in formative pilot and support scripts and associated text messages were created Important to have both advisory board and intervention developers review pilot design and timing Important to have intervention developers review PMI scripts and texting form or content (Draft 1 completed) Texting platforms vary in terms of capacity, functionality, and cost. Total program costs should be estimated
5. Topical experts			Obtained review advice regarding HIPAAd issues relevant to texting Obtained review advice regarding pre- and postintervention CASIe instruments for future effectiveness pilot Met with texting companies (with advice from ITf) for future effectiveness pilot		CASI content should be reviewed for duplication or replication as well as total time required (test run the instrument) Texting is not encrypted, so both HIPAA (and local IRBg/state) requirements must be reviewed regarding texted data and data privacy issues Role, functionality, and cost of texting companies were more clearly defined with this experience Overall costs for the 8-week formative pilot were made
6. Integration			Integrated Draft 1 and topical expert comments for scripts, SMS texting content or form (Draft 2) Conducted Afiya workshop with advisory board Integrated topical expert comments of pre- and postworkshop CASI materials Integrated Draft 2 and CASI components (Draft 3) Final review by advisory board and Afiya and HORIZONS creators		Draft 2 completed Draft 3 completed Final formative pilot design completed
7. Training			Created training materials for the formative pilot		Formative pilot materials completed
8. Testing			Submitted to IRB for clearance of the formative pilot		Obtained IRB clearance to determine adaptation efficacy
	Step 1: formative pilot
		Conducted 8-week formative pilot with advisory board: primary Afiya intervention, 4-week texting, focus group 1 (adjustments), 4-week texting, focus group 2 (adjustments)		Iterative pilot design provided important feedback on texts (timing, wording, dose) as well as script and CASI modifications Information gathered during the first advisory board focus group was applied to modifying the second 4-week texting session, information gathered during the second 4-week focus group was also useful (topic experts were consulted during these sessions as necessary) 5 personas identified, exit interviews added Results informed design of adaptation impact pilot
	Step 2: feasibility pilot
		Designed texting PMI RCTh feasibility pilot study Study methods submitted to IRB for approval		Obtained IRB clearance for 3-arm feasibility pilot study Preparing for PMI RCT feasibility pilot study to examine short-term intervention efficacy

^aSTI: sexually transmitted infection.

^bPMI: preventive maintenance intervention.

^cmHealth: mobile health.

^dHIPAA: Health Insurance Portability and Accountability Act.

^eCASI: computer-assisted self-interview.

^fIT: information technology.

^gIRB: Institutional Review Board.

^hRCT: randomized controlled trial.