Examining cultural adaptations of the savvy caregiver program for Korean American caregivers using the framework for reporting adaptations and modifications-enhanced (FRAME)

In creating K-Savvy, a total of 32 modifications were made to the SCP. Although each of these modifications are detailed elsewhere [15], in the present study our aim was to document them using the FRAME categorization. Table 2 shows how these modifications were categorized within the FRAME domains, and summary statistics are provided in Table 3. The areas of adaptation were evenly distributed across context (37.5%), content (31.2%), and training (31.2%). The research team made recommendations and decisions for all modifications; others who contributed to changes included trainers (62.5%), caregiver participants (34.3%), advisory panel members (34.3%), and the SCP developer (25%). Since multiple stakeholders were involved in these recommendations and changes, totals are shown as greater than 100%. Input from the SCP developer was critical for maintaining fidelity to the SCP. For example, given the length of the caregiver manual (290 pages), a shorter version was suggested. However, this was rejected by the SCP developer in order to preserve all essential elements of the original SCP manual. Instead, weekly handouts outlining the manual’s content were provided as a reference. Augmenting content to reframe the SCP’s individualistic values (e.g., personhood, self-care, self-efficacy) for the target group’s collectivistic cultural context was strongly endorsed by the SCP developer, resulting in the modification of content. Apart from the translation of the manual and the certification of the bilingual trainers, most of the modifications (78.1%) were made after pilot implementation. Five modifications to the SCP (15.6%) were planned during pre-implementation and reconfirmed during pilot implementation. For example, the use of the word “Savvy” without translation into Korean was planned before the pilot test, and this was strongly endorsed by both caregiver participants and trainers. In qualitative interviews conducted after the pilot test, participants and trainers reported that the word Savvy fit well with the program and was impactful. They also suggested branding the program as K-Savvy and including a brief discussion of the program’s name during the first session, which the research team and the SCP developer approved.

Planning was closely aligned with timing. All modifications made during pre-implementation were planned and proactive, whereas those made after pilot implementation were unplanned and reactive because they were in response to the needs emerged during implementation. The five modifications that spanned both phases were both proactive and reactive. Given the study design with data-driven adaptation and close alignment with the SCP [15], most modifications (94%) were either fully or partially reactive, and all ensured fidelity. Only three modifications represented temporary drifts specific to pilot implementation, whereas the rest permanently applied to the entire program. Attending an alternative class was the only modification applicable to a specific target subgroup with a schedule conflict during the pilot implementation. Over a quarter of the modifications (28.1%) applied to the trainer group, and only one modification applied to a specific trainer subgroup. Booster training sessions were suggested only for trainers who needed additional training. The primary reasons for modification were for engagement (62.5%), fit with recipients (43.8%), and outcomes (31.1%). Many efforts to improve fit with recipients by addressing their linguistic and cultural needs were also linked with the goals of enhancing participants’ engagement and intervention outcomes.