Washington-Nortey M
Mwangome E
Demissie M
Angwenyi V
Lewa V
Ombech E
Yao Y
Eshetu T
Abdurahman R
Girma F
Tsigebrhan R
Who Cst Team
Pacione L
Salomone E
Servili C
Abubakar A
Newton CR
Hoekstra RA
Transl Behav Med. 2026;16
BACKGROUND: Despite the increasing evidence on the importance of contextual adaptation of interventions, there is limited understanding of how intervention adaptations made for one context can inform adaptation and implementation efforts in others or how to harmonize adapted interventions for use across multiple contexts. PURPOSE: This paper outlines the process used to further adapt and harmonize previous Kenyan and Ethiopian cultural and contextual adaptations of the World Health Organization's Caregiver Skills Training intervention as a case study to propose a framework for similar efforts. It also outlines key lessons learned. RESULTS: The Compare, Decide, Develop drafts, and Test and train (CoDDaT) framework is a four-phased, stepwise approach to intervention adaptation and harmonization that involves: (i) comparing available intervention materials and measures across contexts, (ii) deciding in collaboration with key stakeholders on adaptations needed, (iii) developing drafts of harmonized intervention materials and measures, and (iv) testing harmonized intervention materials and measures and training staff. It complements existing implementation frameworks by describing the preparatory phase ahead of implementing an adapted or harmonized project. Critical lessons learned included the importance of accurate documentation, the team's phase-specific size and composition, time management, and the opportunities for network growth and skills development offered by the harmonization process. CONCLUSIONS: We demonstrate how lessons from context-specific adaptations can be applied cross-culturally, while incorporating critical revisions and preserving core intervention components. CoDDaT may inform efforts to adapt and implement interventions to promote health behavior change across contexts and advance the field by challenging interventionists to move beyond single-context-focused adaptations and consider applying adapted interventions to other similar contexts, harmonizing, or refining adapted interventions for more extensive use.
A growing number of research papers provide guidance on how to adapt interventions, developed for use in one country, to work well in another setting. However, there is little guidance on how intervention adaptations made for one context can inform adaptation and implementation efforts in other settings, or how to incorporate lessons learnt from adaptations made for different contexts into a new "harmonized" version. We created a step-by-step guide called the Compare, Decide, Develop drafts, and Test and train (CoDDaT) framework. It shows readers how to carefully consider and potentially combine different versions of an intervention program into one, while striving to retain the intervention's essence and core components. There are four main steps: (1) Collect and compare all adaptations of the program and tools used in similar places. (2) Discuss with teams and stakeholders on what is similar and what is different and decide on what to include or change. (3) Develop Drafts: Write up an adapted version of the program based on those decisions. (4) Test and Train: Try out the new version, train the team to use it and collect feedback. We used a real example based on the World Health Organization's Caregiver Skills Training program, which helps caregivers of children with developmental disabilities, to illustrate the CODDaT process and the lessons we learnt in harmonizing this program for use in Ethiopia and Kenya. The lessons learnt included the importance of documenting all procedures and discussions, selecting the right team for each part of the process, working efficiently, and leveraging the insights and skills gained through the harmonization process. Using the CoDDaT framework to create a harmonized intervention allows researchers to benefit from insights from many places and can save time in developing a good new adaptation.
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