Behavior change interventions to improve the health of racial and ethnic minority populations: a tool kit of adaptation approaches

Milbank Q. 2013 Dec;91(4):811-51. doi: 10.1111/1468-0009.12034.


Context: Adapting behavior change interventions to meet the needs of racial and ethnic minority populations has the potential to enhance their effectiveness in the target populations. But because there is little guidance on how best to undertake these adaptations, work in this field has proceeded without any firm foundations. In this article, we present our Tool Kit of Adaptation Approaches as a framework for policymakers, practitioners, and researchers interested in delivering behavior change interventions to ethnically diverse, underserved populations in the United Kingdom.

Methods: We undertook a mixed-method program of research on interventions for smoking cessation, increasing physical activity, and promoting healthy eating that had been adapted to improve salience and acceptability for African-, Chinese-, and South Asian-origin minority populations. This program included a systematic review (reported using PRISMA criteria), qualitative interviews, and a realist synthesis of data.

Findings: We compiled a richly informative data set of 161 publications and twenty-six interviews detailing the adaptation of behavior change interventions and the contexts in which they were undertaken. On the basis of these data, we developed our Tool Kit of Adaptation Approaches, which contains (1) a forty-six-item Typology of Adaptation Approaches; (2) a Pathway to Adaptation, which shows how to use the Typology to create a generic behavior change intervention; and (3) RESET, a decision tool that provides practical guidance on which adaptations to use in different contexts.

Conclusions: Our Tool Kit of Adaptation Approaches provides the first evidence-derived suite of materials to support the development, design, implementation, and reporting of health behavior change interventions for minority groups. The Tool Kit now needs prospective, empirical evaluation in a range of intervention and population settings.

Keywords: diet; ethnicity; exercise; race; smoking cessation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Asian Americans / psychology*
  • Blacks / psychology*
  • Diet / ethnology
  • Diet / methods
  • Ethnicity / psychology*
  • Health Promotion / methods
  • Humans
  • Minority Groups / psychology*
  • Motor Activity
  • Risk Reduction Behavior*
  • Smoking Cessation / ethnology
  • Smoking Cessation / methods
  • United Kingdom