A qualitative study of modifications and adaptations to an evidence-based prevention intervention during implementation on college campuses

Rates of eating disorders increase during young adulthood, but access to evidence-based intervention is limited in routine healthcare settings such as on college campuses. A preventive approach and task-shifting eating disorder interventions to peer educators trained by on-campus supervisors might increase access, but may introduce changes as they move further from developer oversight. Modifications are commonplace during implementation in routine care settings; understanding the nature of these modifications can help to clarify whether they improve intervention fit or undermine fidelity. Peer education supervisors from 63 colleges that implemented an evidence-based preventive intervention for eating disorders (<i>Body Project)</i> as part of a larger randomized trial completed semi-structured interviews about modifications made to the <i>Body Project</i> when it was delivered by peer educators. Thematic analyses of the interviews using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) suggested that modifications were primarily fidelity-consistent, adherent, planned/proactive, and made to improve fit with recipients. Results support prior work suggesting that delivery of evidence-based interventions in routine settings may require at least minor modifications to meet recipient needs without compromising fidelity. This study was preregistered with ClinicalTrials: https://clinicaltrials.gov/ct2/show/NCT03409809.