Table 1.

Development of the Mlambe Intervention using the ADAPT-ITT Framework

ADAPT-ITT Step	Question Answered by Step	Methodology Used
1. Assessment	Who is the target population and why is alcohol a problem?	• Collected and evaluated mixed-methods data with target population of couples who drink alcohol in Malawi.
2. Decision	What evidence-based intervention (EBI) is going to be selected and is it going to be adopted or adapted?	• Identified need for combined economic and relationship-strengthening intervention. • Reviewed literature for EBIs, consulted experts, and held team meetings. • Made decision to adapt Suubi for economic component and Uthando Lwethu for relationship component.
3. Administration	What in the EBI needs to be adapted and how should it be adapted?	• Presented intervention concept to academic experts and key stakeholders for feedback. • Explored elements of the interventions to adapt.
4. Production	How do you produce a draft of the intervention and document adaptations?	• Generated draft of Mlambe manual and curriculum for combined intervention based on existing manuals and materials. Tailored the content for contextual issues in Malawi (literacy issues, common words/phrases) and to specifically address alcohol use.
5. Topic experts	Who can help to adapt the EBI?	• Conducted focus group discussions with couples and key stakeholders for input.
6. Integration	What is going to be included in the adapted EBI that is to be piloted?	• Analyzed focus group discussion (FGD) data to further refine the manual and intervention design.
7. Training	Who needs to be trained and how?	• Generated facilitator training manual and conduct trainings with facilitators.
8. Testing	Was the adaptation successful and how did it improve alcohol outcomes?	• Developed study procedures and data collection instruments for pilot randomized controlled trial to follow.