Nursing ETDs

Publication Date

Fall 12-20-2018


One of the most challenging barriers to implementing successful and sustainable evidence-based programs in public health is the ability to remain faithful to original protocols grounded in scientific evidence while adapting programmatic components to reflect the reality of the communities they are meant to benefit. It is generally accepted that some degree of adaptation should occur in order to achieve positive, sustainable outcomes in public health programs. A concept mapping methodology was used to explore types of adaptation that occur during implementation of evidence-based global health programs in low- to middle-income countries (LMICs). Purposive and snowball sampling produced a sample (N=24) of those who have implemented evidence-based public health programs in LMICs. CS Global MAX™ software was used for participant phases and for data analysis. A 10-cluster solution was chosen by the researcher based on participant groupings and includes the following adaptation categories: (1) Culturally Appropriate Communication, (2) Monitoring & Evaluation, (3) Human Resources, (4) Capacity Building, (5) Community Input, (6) Local Expertise, (7) Evidence Transition to Local Context, (8) Technology and Incentives, (9) Transparency, and (10) Cultural Considerations. Pattern matching displays and bivariate plots, “go-zones,” were used to evaluate the clusters in terms of importance and ease. Clusters such as Culturally Appropriate Communication and Monitoring & Evaluation were considered both important and relatively easy to complete whereas the Human Resources cluster was considered to be both unimportant and difficult to achieve. This study produced a unique conceptualization of adaptation categories by using a unique mixed methods analysis to conceptualize adaptation categories, was one of only four studies to interview actual implementers, the only study that included implementers from a variety of LMICs that drew from several types of public health program, and has uniquely assessed the relative importance and ease of adaptations from the viewpoint of program implementers.

Degree Name


Level of Degree


Department Name

College of Nursing

First Committee Member (Chair)

Beth Tigges

Second Committee Member

Nancy Ridenour

Third Committee Member

Kim Cox

Fourth Committee Member

Stephanie Smith


implementation, adaptation, concept mapping, low-to middle-income countries



Document Type