Adaptation of an evidence-based parenting intervention for integration into maternal-child home-visiting programs: Challenges and solutions

Background The objective of this study was to assess potential challenges, prioritize adaptations, and develop an implementation and research approach to integrate and study a parenting intervention for mothers in recovery from substance use disorders in community-based home-visiting programs.Method An explanatory mixed-methods design, guided by process mapping with Failure Modes and Effects Analysis tools, and an Advisory Panel of 15 community members, identified potential implementation challenges and recommended solutions for the proposed intervention within five pre-specified domains. Thematic content analysis identified themes from detailed field notes.Results The Advisory Panel identified 44 potential challenges across all domains. They determined that the recruitment domain was most likely to create challenges. Regarding the potential challenges, two cross-domain themes emerged: (1) development of mistrust in the community and (2) difficulty initiating and sustaining engagement. Potential solutions and adaptations to protocols are reported.Conclusion Mistrust in the community was cited as a potentially important challenge for the delivery and study of an evidence-based parenting intervention for mothers in recovery through home-visiting programs. Adaptations to research protocols and intervention delivery strategies are needed to prioritize the psychological safety of families, particularly for groups that have been historically stigmatized. Effective evidence-based public health interventions for women and children face common implementation challenges in community-based settings, frequently yielding lower benefits to participants. Adaptation can improve the integration of interventions in these settings. In this study, implementation process mapping was a particularly effective approach to adapt a complex community-based intervention to a population that has been stigmatized. This tool may be useful for adapting other community-based interventions.