Adapting intervention approaches to new contexts: Three case studies of international adaptation of the Teen Online Problem Solving (TOPS) program.
Shari L Wade, Kelly M Jones, Claudia Corti and 4 others
PMID 34871027WHAT IT FOUND
Adapting the Teen Online Problem Solving program for Italy, New Zealand, and the UK required changing videos, language, and session structures to match local school systems, healthcare models, and cultural norms like Māori protocols.
Key findings
01Cultural context drove specific content changes, such as emphasizing nonverbal communication in Italian videos and integrating Māori practices and language into the New Zealand version.
02Structural adaptations were necessary to align with local realities, including removing insurance references in Italy and reducing core sessions in the UK to address specific behavioral concerns like anxiety or aggression.
03Stakeholder feedback identified practical barriers to implementation, such as the need for shorter sessions for busy parents in New Zealand and recruitment difficulties in the UK due to lack of contact data.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is a descriptive report of adaptation processes, not a clinical trial, so it provides no evidence that the adapted programs improve patient outcomes. The methods for gathering stakeholder feedback varied significantly across the three countries, making it difficult to compare the effectiveness of different adaptation strategies. The adaptations did not strictly follow established guidelines for cross-cultural translation. The UK case highlighted significant recruitment challenges, with nearly 60% of identified eligible participants unable to be contacted, suggesting systemic barriers to access even with telehealth.
Declared interests
The study was supported by the Italian Ministry of Health, the National Institute for Health Research (NIHR) in the UK, and external funding for the New Zealand adaptation. Author SW was a co-applicant for funding at each site.
The easy way to misread this
Do not interpret this paper as evidence that the adapted TOPS programs are effective treatments. The study describes the process of changing the program to fit local cultures and reports only on acceptability and feasibility, not on clinical outcomes or efficacy.