Harmonizing adapted interventions across contexts: lessons from harmonizing the World Health Organization’s Caregiver Skills Training in Ethiopia and Kenya

Journal article

Lay Summary: 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.

Authors: Washington-Nortey, M; Mwangome, E; Demissie, M; Angwenyi, V; Lewa, V

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Oxford University Press
• Journal: Translational Behavioral Medicine
• Volume: 16
• Issue: 1
• Article number: ibag003
• Publication date: 2026-04-09
• Acceptance date: 2025-12-16
• DOI: 10.1093/tbm/ibag003
• EISSN: 1613-9860
• ISSN: 1869-6716
• Language: English
• Keywords: Low-and Middle-Income Countries; Psychosocial Intervention; Contextual Adaptation; Clinical Trials; Implementation Science; Developmental Disabilities