How can complex interventions be adapted to context? A qualitative analysis of the implementation of DREAMS in three Kenyan settings
5 affiliations
- 1Faculty of Epidemiology and Population Health, LSHTM, London, United Kingdom
- 2Kenya Medical Research Institute, Kisumu, Kenya
- 3African Population and Health Research Centre, Nairobi, Kenya
- 4Independent Consultant, Tannay, Switzerland
- 5University of Cape Town, Cape Town, South Africa
Abstract
In Kenya, the DREAMS Partnership (“Determined, Resilient, Empowered, AIDS-free, Mentored and Safe”) aims to reduce new HIV cases among adolescent girls and young women (AGYW; aged 10–24) through a comprehensive programme of interventions. The impact of DREAMS varies across settings but reasons for this are not well understood. One potential reason is the differential implementation of DREAMS interventions due to on-the-ground adaptations made by implementers. We sought to understand if, how, and why DREAMS delivery was adapted in three Kenyan settings, so that complex interventions like DREAMS can be tailored to diverse contexts and challenges.We analysed 40 transcripts from individual and group discussions with DREAMS implementing teams. Data were collected between 2017–2019 in rural Gem and two Nairobi informal settlements. Using both FRAME and CFIR frameworks, we identified programming and contextual challenges that affected implementation, local adaptations made in response to these realities and challenges, and the goals and reasoning for adaptation. Reasons for adapting DREAMS were similar across settings yet the type of adaptation varied by context. Adaptations were made to: 1) improve programme attendance; 2) tailor content to better suit AGYW, encourage programme attendance and address community concerns; 3) support participants’ wellbeing, amidst poverty, hunger and violence; and 4) cope with insufficient programming resources. Given their close contact with participants and families, DREAMS mentors often developed unique context-specific strategies to make interventions more appealing and accessible to participants of different ages and circumstances. Understanding shared reasons for adaptation across settings can help anticipate challenges before implementation, and inform the co-design of interventions with communities. As context-specific issues inevitably arise during implementation, mentors can be instrumental in adapting DREAMS, serving as a bridge between programme implementers and beneficiaries. Supporting mentors’ ideas and ongoing commitment can ensure that those delivering programmes plan, learn, adapt and improve in partnership with communities.
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BibTeX
@article{hassan2026complex,
title = {{How can complex interventions be adapted to context? A qualitative analysis of the implementation of DREAMS in three Kenyan settings}},
author = {Anushé Hassan and Alizée McLorg and Vivienne Kamire and Venetia Baker and Jane Osindo and Elizabeth Kemigisha and Jane Ferguson and Martina Mchenga and Sian Floyd and Daniel Kwaro and Abdhalah Ziraba and Elona Toska and Brendan Maughan-Brown and Isolde Birdthistle},
journal = {PLOS Global Public Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pgph.0006701},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006701},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - How can complex interventions be adapted to context? A qualitative analysis of the implementation of DREAMS in three Kenyan settings
AU - Anushé Hassan
AU - Alizée McLorg
AU - Vivienne Kamire
AU - Venetia Baker
AU - Jane Osindo
AU - Elizabeth Kemigisha
AU - Jane Ferguson
AU - Martina Mchenga
AU - Sian Floyd
AU - Daniel Kwaro
AU - Abdhalah Ziraba
AU - Elona Toska
AU - Brendan Maughan-Brown
AU - Isolde Birdthistle
PY - 2026
DA - 2026/09/25
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0006701
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006701
AB - In Kenya, the DREAMS Partnership (“Determined, Resilient, Empowered, AIDS-free, Mentored and Safe”) aims to reduce new HIV cases among adolescent girls and young women (AGYW; aged 10–24) through a comprehensive programme of interventions. The impact of DREAMS varies across settings but reasons for this are not well understood. One potential reason is the differential implementation of DREAMS interventions due to on-the-ground adaptations made by implementers. We sought to understand if, how, and why DREAMS delivery was adapted in three Kenyan settings, so that complex interventions like DREAMS can be tailored to diverse contexts and challenges.We analysed 40 transcripts from individual and group discussions with DREAMS implementing teams. Data were collected between 2017–2019 in rural Gem and two Nairobi informal settlements. Using both FRAME and CFIR frameworks, we identified programming and contextual challenges that affected implementation, local adaptations made in response to these realities and challenges, and the goals and reasoning for adaptation. Reasons for adapting DREAMS were similar across settings yet the type of adaptation varied by context. Adaptations were made to: 1) improve programme attendance; 2) tailor content to better suit AGYW, encourage programme attendance and address community concerns; 3) support participants’ wellbeing, amidst poverty, hunger and violence; and 4) cope with insufficient programming resources. Given their close contact with participants and families, DREAMS mentors often developed unique context-specific strategies to make interventions more appealing and accessible to participants of different ages and circumstances. Understanding shared reasons for adaptation across settings can help anticipate challenges before implementation, and inform the co-design of interventions with communities. As context-specific issues inevitably arise during implementation, mentors can be instrumental in adapting DREAMS, serving as a bridge between programme implementers and beneficiaries. Supporting mentors’ ideas and ongoing commitment can ensure that those delivering programmes plan, learn, adapt and improve in partnership with communities.
SN - 2767-3375
ER -