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While questions about adaptation and fidelity are of great concern in manyimplementation projects, less attention has been paid to reasons for adaptations thatremain when evidence-based interventions (EBIs) are used in clinical and communitysettings. This study aims to explore reasons for adaptations that can arise whenusing parenting programs in a community setting. Seventeen individual interviewswith providers were conducted and analyzed thematically, resulting in 11 reasonsfor adaptations organized into four separate areas: characteristics of group leaders(supplementary skills and knowledge, preferred ways of working), characteristics offamilies (problem complexity, diverse or limited educational experience, non-parentingneeds for support, colliding value systems), group incidents (criticism and challenges,excessive questions or discussions), and didactic challenges (lack of focus orengagement, limitations of the material, language differences). The study shows thatfactors triggering adaptation and fidelity decisions continuously reappear in the provisionof parenting programs in community settings. Knowledge about reasons for adaptationcan be used to inform decision-making during implementation planning, as well as thesustainment of implemented interventions.

Background: Evidence-based interventions (EBIs) are frequently modified in practice. It is recommended that decisions to modify EBIs should be made deliberately to ensure fidelity-consistency, yet the relationship between fidelity-consistency and deliberateness is not well understood. This study aims to explore modifications in a sample of practitioners delivering evidence-based parenting programs (i.e., interventions to strengthen parent–child relationships, reduce harmful interactions, and improve child health and well-being). The study investigated three research questions: (1) What kind of modifications are made during the delivery of parenting programs? (2) To what degree are the identified modifications consistent with the core functions of each program? and (3) Is deliberateness associated with the fidelity-consistency of the identified modifications? Methods: In total, 28 group leaders of five widely disseminated parenting programs in Sweden participated in five focus groups, and two participants from each group also participated in individual interviews (n = 10). A content analysis approach was used where the identification of modifications was directed by the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and then assessed for fidelity-consistency and four levels of deliberateness (universal, situational, conditional, and unintentional). Chi-square tests were performed to compare consistent and inconsistent modifications, and logistic regression was performed to explore whether deliberateness predicted consistency. Results: A total of 137 content modifications were identified, covering most of the content modification categories in FRAME. The most common were tailoring/tweaking/refining, adding elements, shortening/condensing, lengthening/extending, and integrating another treatment. Modifications were mostly fidelity-consistent but consistency varied greatly among categories. Furthermore, modifications made unintentionally or situationally were more likely to be fidelity-inconsistent. Conclusions: These results indicate that explicit consideration of modifications and their impact could be essential for sustaining the fidelity-consistent use of EBIs, even as such interventions are continuously modified.