Adapting a brief smoke-free homes intervention for communities in Armenia and Georgia

Evidence-based interventions (EBIs) often require adaptation to be effective for new communities and/or cultural contexts. This paper describes the process for adapting an evidence-based smoke-free homes (SFHs) intervention to be culturally appropriate for households in Armenia and Georgia. The intervention, including three mailed packages ("mailings") and a coaching call, was adapted using a systematic multi-step adaptation process involving: (i) focus groups (n = 8) among adults in Armenia and Georgia, who smoked cigarettes or lived in a household with someone who smoked; (ii) consulting with in-country research team experts and local community leaders; and (iii) collaboratively deciding on critical adaptations, which differed slightly by country. Adaptations spanned across intervention components. While adaptations were largely surface-level (e.g. Armenia- and Georgia-relevant facts, color themes, imagery of individuals, homes, and settings), the process identified needed deep structure changes. For example, the nature of the challenges and solutions addressed, the narratives used for role modeling, and the imagery were adapted to better reflect the smoking-related social norms and dynamics (e.g. greater smoking prevalence among men vs. women, difficulty asking guests/elders to smoke outside), household composition (i.e. multigenerational), types of homes (e.g. ease of access to outdoor spaces), and types of tobacco used (i.e. heated tobacco products). The adapted interventions maintained the core elements and underlying theoretical approach but included adaptations to ensure cultural appropriateness and relevance. This should yield an effective intervention, which will be assessed next. The description of this multi-step adaptation process could inform future efforts to disseminate and implement EBIs across settings globally.