Table 3 Challenges and resulting adaptations around intervention content and delivery

Content perceived to be not suited for patient population

Added or adjusted program content

“I know with the Spanish one she does a lot more visuals because the patients don’t always read all the stuff. For the IDEA approach she printed out a light bulb, and doing more visuals to help with the words that they don’t always read. I think that’s been a little bit helpful.” (health educator, Federally Qualified Health Center #06)

Content difficult to deliver according to program plan/timing

Remove or change timing of content delivery

“I did do the medication one in the first cohort, and it just felt so pressured. One of the patients actually told me she felt overwhelmed. It just seemed like the most practical piece to remove and still have the meat of that whole section in that curriculum.” (BHP, Federally Qualified Health Center #04)

Disagreement with nutrition information/content

Alter or add to program content

“It did seem the carb counting piece is something that we’re just not emphasizing that anymore. They immediately think carbohydrates are the bad guy and remove that from their diet and eat summer sausage and cheese cause that’s the message when you’re carb counting, so therefore carbs must be bad…I also think that class was the longest one and you had one patient comment that they just had so many more questions. They wanted sample meal and snack ideas, some real examples.” (health educator, Private practice #06)

Content difficult for patients with low literacy levels

Added visuals

“Like I mentioned, there’s some patients that didn’t understand the wordy part of some of our things, and so it was just really improvising and trying to show them a way of visually being able to see ‘em” (health educator, Federally Qualified Health Center # 08)

Mental health content not seen as appropriate for patient population

Removed specific content

“I get a little frustrated with the curriculum sometimes. With the curriculum we’re using now, there are components of it where I don’t feel very proficient because they’re so behavior change, mental health focused”(health educator, Federally Qualified Health Center #05)

“The only one that we don’t present too much anymore is the one with the severe mental health problems. It’s going down too deep for a six visit group. Goin’ into schizophrenia meds and stuff like that with these folks…That’s a little too much.” (health educator, Federally Qualified Health Center #05)