14Emad, this is a better effort than the other paper. Howev

1
4
Emad, this is a better effort than the other paper. However, you
still have some sentences that lack clarity and are hard to
understand by the reader. I made changes to the paper to help it
to flow better. It is best to match this paper up with the one I
change to understand better what changes and why. As I stated
before, to write academically, you must write precisely and
succinctly. Let me know if you have any questions. Hang in
there, I know you can get this done. I am here to help! Be safe,
Ensuring Diversity in the Workforce
Emad N. Alkhadabah
Central Michigan University
Master of Science in Administration
MSA 698: Directed Administrative Portfolio
Dr. Larry F. Ross
March 28, 2021
Ensuring Diversity in the Workforce
In the workplace, diversity refers to the encompassing of
different aspects of individuals such as race, ethnicity, gender,
personality, education level, organization leadership occupation
among other factors. Diversity can also be looked into as how
people perceive themselves and others in the workplace. When
an organization is having a diverse workplace, they understand
the demographics and what it’s involved in such groups of
people.
. When an organization does not have diversity inclusion it can

pose disadvantages since there are potential lawsuits on the
creation of equal employment opportunity. These legal suits are
a disadvantage to any business since they tend to be costly and
diverse of the organization’s resources. It can also lead to the
creation of a negative perception of the customers, potential
investors, and future employees. Having diversity inclusion in
an organization is not enough to guarantee the success of an
organization.
Diversity and transformational leadership
Diversity is connected to transforma tional leadership; in a
diverse environment, there will be a lot of assessment that will
take place because different people are involved, and this will
help to monitor the work they are doing. Leaders will have to be
very keen to know the kind of employees they may need
assistance. The other issue connected to transformational
leadership is that once many people from different parts and
with different cultures are involved in the organization, they
will be in a fair and healthy competition. The reason for this is
because different people have different ways in which they are
going to work to make sure that the organization is in safer
hands and it is getting profit just as it is supposed to be doing.
Another important aspect in transformational leadership i s that
it brings training since it enables the organization to appreciate
the individual differences among the employees while at the
same time providing an equal opportunity for all the employees
to exercise potential regardless of their differences. This will
make the organization to have a very smooth working
relationship with all other employees.
When it comes to diversity training, it is supposed to target
everyone in the organization from the top level to the bottom
level. At the top management, diversity training enables the
managers to make decisions and implement policies that can
influence the organization's view on diversity and inclusion,
this is one thing that was not always present with leaders in the
past. They are also responsible for staffing, firing, renting, and
policymaking, impacting the organization's performance. The

top managers can dictate the culture of an organization since the
lower ranks emulate them. The top managers must understand
the impacts that their decision has on all people in the
workplace. The lower ranks are essential to an organization's
success since they are responsible for implementing the
regulations set by the organization. Each employee needs to feel
appreciated regardless of his/her background and this is very
important in making sure that transformational leadership has
been achieved.
Diversity and SWOT analysis
SWOT analysis means that the strengths, weaknesses,
opportunities, and threats of the organization are assessed. This
is to conclude whether having different people in the
organization is bringing strengths and opportunities in the
workplace or are the presence of different people from all
diversities what they are bringing to the organization are
weaknesses and threats. SWOT plays a vital role in studying the
organization; this is through knowing the organization's internal
and external aspects. When weaknesses and threats have been
identified it can become very easy for the organization to know
how it is going to deal with the negative outcomes and at the
same time how it is going to enhance the positive ones.
The organization has adopted inclusion and diversity in its
workforce, it is capable of tapping into its employees' full
potential. All those employees have different abilities and
skills; when all capabilities of different employees are brought
together, there will be enhanced performance of the
organization. This is one of the strengths of having a diverse
workforce. An organization can broaden its viewpoint obtained
from the diverse experiences from the employees who were
obtained from different backgrounds, which can be used as
learning experience. An organization can also have a
competitive advantage in the marketplace since hiring
individuals with different talents enables the organizatio n to
tackle the challenges facing them effectively (Graham et al.,
2017). APA problem corrected!

For the diverse strategic marketing plan to work effectively, the
HR professionals should assess diversity through discussions,
create open forums that enable employees to discuss the
challenges and obstacles of diversity, and conduct satisfaction
surveys. Through this, the top officials will be able to know
how they can curb threats and weaknesses of the organization
mentioned. In the process of developing a marketing plan, the
HR department should ensure that they set a measurable goal
regarding diversity. After the completion of the plan, both the
management and executive should be committed to the goals.
This is supposed to be a collective responsibility for everyone
in the organization but not just the executives and human
resource managers.
Diversity and Business plan development
When the organization adopts the inclusion and diversity
programs, it should ensure that the programs positively reflect
the organization. This can be through ensuring that it complies
with the federal mind state law. This is in terms of the business
plan which they are developing. The business plan should be
complying with the cultures and the beliefs of people they are
serving. A manager in the office may not know what he is
supposed to do and may not know what those in the ground want
the organization to deal with so that the organization can impact
the locals. With having majority of the organization staff
coming from different and diverse worlds knowing what kind of
the products will be good for different groups of people as they
are planning and documenting the business plan will be very
easy. They will not have to spend a lot of money and time as
they are going out to the field to make research. This is because
people who have interacted with such people will always be in
the organization and they will be providing any information in
case there is a need for that. This is very important because the
company will not spend any extra cost as they try to do some
research. It will also minimize the time which could have been
spent in the field.
Diversity and market assessment

Market assessment is very important, this is because with many
people from different places, they are going to know what their
local people are lacking and what they could have accepted
willingly if the company embarked in producing such products.
The other way for assessing the market is ensuring that
feedback should be taken from the customers and if it is
possible all those feedbacks are supposed to be incorporated and
whatever they had said should be taken into consideration. This
is because most of the loyal clients will give out their honest
feedback and in case this is used for the right purpose, and it
will make sure that the company's brand is continuing to
improve. With such information and feedback, it will be of so
much value to make sure that the next campaign will be
containing what the customers had previously listed. This is
most cases it is going to act as the motivating factor. They are
going to make sure that they are supporting whatever the
organization is coming up with and the reason for doing this is
that they are going to feel like they are part and parcel of the
organization and this is going to make them own whatever is
being done in the organization, (Chau et al. 2019).
The reason why campaigns are supposed to be carried out is to
ensure that there is a lot of collection of as much data as
possible. In most cases, it will be off so much important to
focus on the future for the organization. The data will be
collected from the feedback of the customers and other
stakeholders and it will be analyzed by using qualitative
analysis of data since it cannot be quantified as it answers
questions on why. This is going to attract all meaningful
insights from the data. This will help the organization to know
which the best tactics are. The tactics are going to get the most
appropriate picture of how things are on the ground. Such
insight should never be ignored (Del et al. 2019)
Diversity and marketing strategy
Embracing diversity in the creative team is very essential in
ensuring that the marketing strategy is diverse. This is to create
an authentic message for the diverse team. When many people

are being engaged in any forum, for instance in marketing
strategy, one can be able to get variety of information regarding
what consumers in the ground would want. These insights
choosing the best and the most effective strategy will be very
easy. All people are supposed to be involved before any
information is developed. This is because with these the
information will be incorporating all that people would need to
hear. This is either as they are old, young, whether they live
with diversity or from different cultures. Most people buy the
product if they are sure, and they have been convinced that the
product is the best for them at that very time. Therefore,
embracing diversity within the whole team is very important
and it is going to make the organization sell more and in the
long run, they are going to make as much profit as possible.
organizations are also supposed to make sure that they are
striving and building diversity in the workplace through crafting
a team that has got different backgrounds, philosophies and also
help in improving the marketing strategies, through this, there
will be high chances that there will be a diversity of marketing
flow which will come out from the team.
When one wants to achieve the best diverse marketing, they
should use an effective strategy, (Khan et al. 2019). The most
effective one is a campaign this is because with these
campaigns different and large numbers of people are going to
know about the existence of the product. The campaign will not
be restricted to any people, but instead, it will include all
people without minding where they are from or which religion
or culture they subscribe to. This is because there will be a lot
of learning which will be taking place. People are going to
know so much about the organization as well. During the
campaigns, they will be given a chance to be able to ask
anything that they would feel that they would need any form of
clarification.
Building from the ground up
When it comes to diversity, the organization is supposed to use
a brand message is supposed to be as clear and direct to the

point as possible. This is because with that all people who are
going to come across such a message are going to understand
what is happening. This is because various people are the target
group, for instance, women, men, children, young and older
adults. The message is supposed to be modified so that it could
be able to fit into each of the groups that are going to be the
target groups. This is because if one kind of message is used in
all groups of people in most cases it is going to fail.
Using of organic messages which is unique from each group is
important since the needs which are specific to different groups
of people have been identified and it has been acted
accordingly. The desires as well are supposed to be considered
and at the same time whether those certain groups have any
prior information about whatever is being marketed (Ng et al.,
2020). APA problem corrected! The reason for his is that if they
have the bases the information is not supposed to come as a
brand-new thing, but just little modifications are the ones which
are supposed to be done to make sure that there is no confusion
which is being caused about the product.
Understanding inclusivity languages
To create campaigns and other strategies that are going to be
used for marketing in a diverse capacity, one must be aware of
the audience that one will speak with. However, despite the
understanding of the audience is essential it is not necessary
that the message which is going to be written is supposed to be
very direct and at the same time they are going to exclude
others. One is trying and understanding the language that the
audiences are speaking so that there will be no language barrier
that can hinder the work which the campaign wants to achieve.
However, because of diversity, one is supposed to be very
familiar with as many languages as possible to make sure that
there are at no point will there be a language barrier but at least
there will be communication even though it is not that fluent
communication but at least one will be in a position to at least
say something which will help ensure that the strategies have
had an impact to all the people whom they have been met. There

must be a language that is all-inclusive as well this is especially
in all the aspects of the campaigns and this will make the whole
process to be target-specific and at the same time, it will
welcome others since they can be in a position to understand
what is going on, (Ashe, et al, 2017). The crafting of a diversity
statement is very essential, and it is going to act as a motivation
for many other clients.
Conclusion
The employees have not accepted diversity in the workplace,
and there is a high possibility of having a misunderstanding,
conflicts that will eventually prevent the organization from
achieving its objectives. For the employees to accept diversity,
the organization must set a strategic plan that includes diversity
training to enable employees’ diversity and teamwork, leading
to attaining the organization’s objectives. The paper has
discussed how it has enabled organization to have
transformational leadership and SWOT analysis as well.
APA problem – page break needed to land on the reference page
and keep it from moving.
References
Ashe, S., & Nazroo, J. (2017). Equality, diversity and racism in
the workplace: A qualitative analysis of the 2015 race at work
survey. Online: http://hummedia. manchester. ac.
uk/institutes/code/research/raceatwork/Equ
Chau, J. Y., Engelen, L., Kolbe-Alexander, T., Young, S.,
Olsen, H., Gilson, N., ... & Brown, W. J. (2019). “In Initiative
Overload”: Australian perspectives on promoting physical
activity in the workplace from diverse industries. International

journal of environmental research and public health, 16(3), 516.
del Carmen Triana, M., Richard, O. C., & Su, W. (2019).
Gender diversity in senior management, strategic change, and
firm performance: Examining the mediating nature of strategic
change in high tech firms. Research Policy, 48(7), 1681-1693.
Graham, M. E., Belliveau, M. A., & Hotchkiss, J. L. (2017).
The view at the top or signing at the bottom? Workplace
diversity responsibility and women’s representation in
management. ILR Review, 70(1), 223-258.
Khan, M. S., Lakha, F., Tan, M. M. J., Singh, S. R., Quek, R. Y.
C., Han, E., ... & Legido-Quigley, H. (2019). More talk than
action: gender and ethnic diversity in leading public health
universities. The Lancet, 393(10171), 594-600.
Ng, E. S., & Sears, G. J. (2020). Walking the talk on diversity:
CEO beliefs, moral values, and the implementation of
workplace diversity practices. Journal of Business
Ethics, 164(3), 437-450.
References are not 0/0/doubled-spaced.
Emad, this is a better effort than the other paper. However, you
still have some sentences that lack clarity and are hard to
understand by the reader. I made changes to the paper to help it
to flow better. It is best to match this paper up with the one I
change to understand better what changes and why. As I stated
before, to write academically, you must write precisely and
succinctly. Let me know if you have any questions. Hang in
there, I know you can get this done. I am here to help! Be safe,
Dr. Ross.
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1
Title of the Paper in Full

Student Name
Program Name or Degree Name (e.g., Master of Science in
Nursing), Walden University
COURSE XX: Title of Course
Instructor Name
Month XX, 202X
Abstract
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kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt uuuu vvvv
wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff gggg hhhh
iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr sssss tttt
uuuu vvvv wwww xxxx yyyy zzzz. AAA bbb cccc dddd eeee ffff
gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo pppp qqqq rrrr
sssss tttt uuuu vvvv wwww xxxx yyyy zzzz.
Title of the Paper in Full
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dddd eeee ffff gggg hhhh iiii jjjj kkkk llll mmmm nnnn oooo
pppp qqqq rrrr sssss tttt uuuu vvvv wwww xxxx yyyy zzzz.
Level 1 Heading

Level 2 Heading
Another Level 2 Heading
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jjjj kkkk llll mmmm. AAA bbb cccc dddd eeee ffff gggg hhhh
Level 4 Heading. AAA bbb cccc dddd eeee ffff gggg hhhh iiii
jjjj kkkk llll mmmm. AAA bbb cccc dddd eeee ffff gggg hhhh
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Level 3 Heading
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Level 1 Heading

References
(Note that the following references are intended as examples
only.)
American Counseling Association. (n.d.). About
us.https://www.counseling.org/about-us/about-aca
Anderson, M. (2018). Getting consistent with consequences.
Educational Leadership, 76(1), 26-33.
Bach, D., & Blake, D. J. (2016). Frame or get framed: The
critical role of issue framing in nonmarket management.
California Management Review, 58(3), 66-87.
https://doi.org/10.1525/cmr.2016.58.3.66
Burgess, R. (2019). Rethinking global health: Frameworks of
Power. Routledge.
Herbst-Damm, K. L., & Kulik, J. A. (2005). Volunteer support,
marital status, and the survival times of terminally ill patients.
Health Psychology, 24(2), 225–229.
https://doi.org/10.1037/0278-6133.24.2.225
Johnson, P. (2003). Art: A new history. HarperCollins.
https://doi.org/10.1037.0000136-000
Lindley, L. C., & Slayter, E. M. (2018). Prior trauma exposure
and serious illness at end of life: A national study of children in
the U.S. foster care system from 2005 to 2015. Journal of Pain
and Symptom Management, 56(3), 309–317.
https://doi.org/10.1016/j.jpainsymman.2018.06.001
Osman, M. A. (2016, December 15). 5 do’s and don’ts for
staying motivated. Mayo Clinic.
https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-
depth/5-dos-and-donts-for-staying-motivated/art-20270835
Sue, D. W., & Sue, D. (2016). Counseling the culturally
diverse: Theory and practice (7th ed.). Wiley.

Walden University Library. (n.d.). Anatomy of a research
article [Video].
https://academicguides.waldenu.edu/library/instructionalmedia/t
utorials#s-lg-box-7955524
Walden University Writing Center. (n.d.). Writing literature
reviews in your graduate coursework [Webinar].
https://academicguides.waldenu.edu/writingcenter/webinars/gra
duate#s-lg-box-18447417
World Health Organization. (2018, March). Questions and
answers on immunization and vaccine
safety.https://www.who.int/features/qa/84/en/
Review Article
Content analysis and thematic analysis: Implications for
conducting a qualitative descriptive study
Mojtaba Vaismoradi, PhD, MScN, BScN,1,3 Hannele Turunen,
PhD, RN2 and Terese Bondas, PhD, RN2,3
1College of Human and Health Sciences, Swansea University,
Swansea, UK, 2Department of Nursing Science, Kuopio
Campus, University of Eastern Finland, Kuopio, Finland and
3Faculty of Professional Studies, University of Nordland,
Bodø, Norway
Abstract Qualitative content analysis and thematic analysis are
two commonly used approaches in data analysis of
nursing research, but boundaries between the two have not been
clearly specified. In other words, they are
being used interchangeably and it seems difficult for the
researcher to choose between them. In this respect,
this paper describes and discusses the boundaries between
qualitative content analysis and thematic analysis

and presents implications to improve the consistency between
the purpose of related studies and the method
of data analyses. This is a discussion paper, comprising an
analytical overview and discussion of the definitions,
aims, philosophical background, data gathering, and analysis of
content analysis and thematic analysis, and
addressing their methodological subtleties. It is concluded that
in spite of many similarities between the
approaches, including cutting across data and searching for
patterns and themes, their main difference lies in
the opportunity for quantification of data. It means that
measuring the frequency of different categories and
themes is possible in content analysis with caution as a proxy
for significance.
Key words content analysis, nursing, qualitative descriptive
research, thematic analysis.
INTRODUCTION
In health care, qualitative methodologies aim to explore
complex phenomena encountered by nurses, other providers,
policy makers, and patients (Denzin & Lincoln, 2000;
Sandelowski & Barroso, 2003a; Tong et al., 2007). The phi -
losophy and the basic principles of methodologies, study
aims and questions, and designs and data gathering criteria
provide key differences between qualitative and quantitative
methodologies (Ayres, 2007a). A belief in multiple realities, a
commitment to identifying an approach to in-depth under-
standing of the phenomena, a commitment to participants’
viewpoints, conducting inquiries with the minimum disrup-
tion to the natural context of the phenomenon, and reporting
findings in a literary style rich in participant commentaries
are the main characteristics of qualitative methodologies
(Streubert Speziale & Carpenter, 2007).

Qualitative methodologies consist of the philosophical
perspectives, assumptions, postulates, and approaches that
researchers employ to render their work open to analysis,
critique, replication, repetition, and/or adaptation and to
choose research methods. In this respect, qualitative method-
ologies refer to research approaches as the tools with which
researchers design their studies, and collect and analyse their
data (Given, 2008). Qualitative methodologies are not a
single research approach, but different epistemological per -
spectives and pluralism have created a range of “approaches”
such as grounded theory, phenomenology, ethnography,
action research, narrative analysis, and discourse analysis.
Qualitative research in the field of health has, at times,
been undertaken without identification of the specific meth-
odology used. The term “approach” is used in this article to
differentiate it from the narrower term “methods.” This indi -
cates a coherent epistemological viewpoint about the nature
of enquiry, the kind of knowledge discovered or produced,
and the kind of strategies that are consistent with this
(Giorgi, 1970; Holloway & Todres, 2005).
Qualitative approaches share a similar goal in that they
seek to arrive at an understanding of a particular phenom-
enon from the perspective of those experiencing it. There-
fore, the researcher needs to determine which research
approach can answer their research questions (Streubert
Speziale & Carpenter, 2007). There is a considerable overlap
among available qualitative approaches in terms of methods,
procedures, and techniques. Such an overlap of epistemologi -
cal, aesthetic, ethical, and procedural concerns can encour -
age a generic view of qualitative research, considering it a
“family” approach in which the similarities are more impor -
tant than the differences, and where the notion of flexibility
becomes an important value and quest. However, there is

another point of view, concerned with how such flexibility can
lead to inconsistency and a lack of coherence (Holloway &
Correspondence address: Hannele Turunen, Department of
Nursing Science, Kuopio
Campus, University of Eastern Finland, Kuopio, Finland. PO
Box 1627, 70211
Kuopio. Email: [email protected]
Conflict of interest: None.
Received 20 March 2012; revision received 30 December 2012;
accepted 28 January
2013.
bs_bs_banner
Nursing and Health Sciences (2013), 15, 398–405
© 2013 Wiley Publishing Asia Pty Ltd. doi: 10.1111/nhs.12048
Todres, 2003). It should not be forgotten that consumers of
research assess the quality of evidence offered in a study by
evaluating the conceptual and methodological decisions the
researchers have made. Therefore, the researcher needs to
make good decisions to produce evidence of the highest pos-
sible quality (Polit & Beck, 2003; Høye & Severinsson, 2007).
Aim
Nurse researchers need to delineate and recognize the char -
acteristics of the approach they are going to use in their
studies to improve validity, and the consistency between the
purpose of the study and the method of data analysis. There-
fore, this article describes and discusses the boundaries
between two commonly used qualitative approaches, content

analysis and thematic analysis, and presents implications to
improve the consistency between the purpose of studies and
the related method of data analysis.
FINDINGS
This article continues with a classification of content analysis
and thematic analysis as descriptive qualitative approaches
to data analysis, and an analytical overview and comparative
discussion of the approaches’ definitions, aims, philosophical
background, and data analysis process. Figure 1 summarizes
the comparison of the main characteristics of thematic analy-
sis and content analysis in the continuum of qualitative
research.
Content analysis and thematic analysis as qualitative
descriptive approaches
According to Sandelowski and Barroso (2003b) research
findings can be placed on a continuum indicating the degree
of transformation of data during the data analysis process
from description to interpretation. The use of qualitative
descriptive approaches such as descriptive phenomenology,
content analysis, and thematic analysis is suitable for
researchers who wish to employ a relatively low level of
interpretation, in contrast to grounded theory or herme-
neutic phenomenology, in which a higher level of interpretive
complexity is required. It is noted that there are different
views with respect to the meaning of description and
interpretation in qualitative research, depending on the
methodological approach. Many researchers believe that
both descriptive and interpretative approaches entail inter -
pretation, even if the interpretive component is downplayed
or masked in discussions of its broader narrative and explo-
ration (Sandelowski, 2010). The value of qualitative descrip-
tion lies not only in the knowledge that can originate from it,
but also because it is a vehicle for presenting and treating

research methods as living entities that resist simple classifi -
cation, and can result in establishing meaning and solid find-
ings (Giorgi, 1992; Holloway & Todres, 2005; Sandelowski,
2010).
Nursing researchers frequently use qualitative content
analysis and thematic analysis as two analysis approaches
in the qualitative descriptive study. However, because the
boundaries and the division between the two have not been
Qualifying Qualita ve design
Quan fying
Aims and
concentra ons
Analyzing narra ve
materials of life
stories
Realist/essen alist
and construc onist,
fac st perspec ve
Descrip on and
interpreta on, both
induc ve and
deduc ve,
emphasizing context,
integra on of
manifest and latent

contents, drawing
thema c map, non-
linear analysis
process, no peer
checking
Analyzing nursing
sensi ve
phenomena,
exploratory work on
the unknown
phenomenon
Communica on
theory, fac st
perspec ve
Descrip on and
more interpreta on,
both induc ve and
deduc ve, danger
of missing context,
possibility of finding
a theme based on
the frequency of its
occurrence, division
of manifest and
latent contents, non-
linear analysis
process

Thema c analysis Content analysis
Philosophical
background
Analysis process
Figure 1. Main characteristics of thematic analysis and
qualitative content analysis in the continuum of the qualitative
methodology.
Qualitative descriptive study 399
© 2013 Wiley Publishing Asia Pty Ltd.
clearly specified, they are often used interchangeably and
there is confusion about their similarities and differences
(Sandelowski & Leeman, 2012), as well as how researchers
should choose between them (Braun & Clarke, 2006). For
instance, it has not been uncommon to find that qualitative
content analysis is classified as a type of narrative analysis
(Sandelowski & Barroso, 2003a; Sparker, 2005). Similarly,
thematic analysis has sometimes been introduced as one
part of phenomenology (Holloway & Todres, 2005) or even
simply ignored in textbooks of qualitative methods. Addition-
ally, a lack of consistency and the absence of a clear boundary
between thematic analysis and qualitative content analysis,
and other analytical qualitative approaches, have resulted in
the application of titles such as “phenomenological thematic
analysis” (Sandelowski & Barroso, 2003a) or “thematic
content analysis” (Green & Thorogood, 2004). Interestingly,
much of the analysis presented in published papers is essen-
tially thematic, but is either described as something else such

as content analysis or simply not identified as a particular
method. For instance, it has been stated that data were sub-
jected to qualitative analysis for commonly recurring themes
(Braun & Clarke, 2006), or there is a lack of identification of
the explicit methodological orientation (Sandelowski &
Barroso, 2003b). Also, some researchers merely describe the
use of qualitative data gathering techniques, such as inter -
views and focus groups, and not enough effort is made to
qualify individual elements of methods other than signaling
the data analysis process as either content or thematic analy-
sis (Sandelowski & Barroso, 2003b). In this respect, there is
a need to clarify and introduce methodological approaches
rarely identified as independent methods (Sandelowski,
2010).
Definition of content analysis and thematic analysis
Content analysis is a general term for a number of different
strategies used to analyse text (Powers & Knapp, 2006). It is
a systematic coding and categorizing approach used for
exploring large amounts of textual information unobtrusively
to determine trends and patterns of words used, their fre-
quency, their relationships, and the structures and discourses
of communication (Mayring, 2000; Pope et al., 2006; Gbrich,
2007).
The purpose of content analysis is to describe the charac-
teristics of the document’s content by examining who says
what, to whom, and with what effect (Bloor & Wood, 2006).
On the other hand, thematic analysis often is seen as a poorly
branded method, in that it does not appear to exist as a
named method of analysis in the same way that content
analysis does. Thematic analysis as an independent qualita-
tive descriptive approach is mainly described as “a method
for identifying, analysing and reporting patterns (themes)
within data” (Braun & Clarke, 2006: 79). It has also been

introduced as a qualitative descriptive method that provides
core skills to researchers for conducting many other forms of
qualitative analysis. In this respect, qualitative researchers
should become more familiar with thematic analysis as an
independent and a reliable qualitative approach to analysis.
Aim and focus of data analysis
It seems that both content analysis and thematic analysis
share the same aim of analytically examining narrative mate-
rials from life stories by breaking the text into relatively
small units of content and submitting them to descriptive
treatment (Sparker, 2005). Both content and thematic analy-
sis approaches are suitable for answering questions such as:
what are the concerns of people about an event? What
reasons do people have for using or not using a service or
procedure? (Ayres, 2007b). Content analysis is well-suited to
analyse the multifaceted, important, and sensitive phenom-
ena of nursing (Elo & Kyngäs, 2008; Vaismoradi et al., 2011).
If conducting exploratory work in an area where not much is
known, content analysis may be suitable for the simple
reporting of common issues mentioned in data (Green &
Thorogood, 2004). It has been suggested that thematic analy-
sis, as a flexible and useful research tool, provides a rich and
detailed, yet complex, account of the data (Braun & Clarke,
2006). Clearly, thematic analysis involves the search for and
identification of common threads that extend across an entire
interview or set of interviews (DeSantis & Noel Ugarriza,
2000).
It should be noted that both approaches allow for a quali-
tative analysis of data. By using content analysis, it is possible
to analyse data qualitatively and at the same time quantify
the data (Gbrich, 2007). Content analysis uses a descriptive
approach in both coding of the data and its interpretation of
quantitative counts of the codes (Downe-Wamboldt, 1992;

Morgan, 1993). Conversely, thematic analysis provides a
purely qualitative, detailed, and nuanced account of data
(Braun & Clarke, 2006).
Philosophical backgrounds
When qualitative approaches are introduced in qualitative
research textbooks, each approach is discussed in the context
of its historical and philosophical background (Streubert
Speziale & Carpenter, 2007). Generally, qualitative
approaches share a broad philosophy, such as person-
centeredness, and a certain open-ended starting point
(Holloway & Todres, 2003).
Communication theory has been introduced as a way to
address the issue of interpretation and to clarify the under -
lying assumptions of content analysis (Graneheim &
Lundman, 2004). Thematic analysis can be conducted within
both realist/essentialist and constructionist paradigms,
although the outcome and focus will be different for each
(Braun & Clarke, 2006). It has also been noted that both
approaches are largely based on the “factist” perspective. A
factist perspective assumes data to be more or less accurate
and truthful indexes of the reality out there (Sandelowski,
2010). In other words, the researcher wants to find out about
the actual behaviour, attitudes, or real motives of the people
being studied, or to detect what has happened (Ten Have,
2004).
According to Sandelowski (2010), a lot of energy is spent
focusing on philosophical details, which often have little or
nothing to do with what the researchers actually do.
400 M. Vaismoradi et al.

However, the philosophical starting points of the study
should not be forgotten when seeking differences and simi -
larities in the approaches (Bondas & Hall, 2007). The actual
implementation of the methods and understanding their sub-
tleties in the data analysis process should receive greater
attention from nurse educators and qualitative researchers.
Exploration of the data analysis process
Both content analysis and thematic analysis are used in
nursing studies. Nevertheless, a scarcity of information about
the process of data analysis in nursing literature has resulted
in a diversity of perspectives on how the approaches are used
in research practice (Braun & Clarke, 2006; Elo & Kyngäs,
2008). A unified and standard data analysis protocol is pre-
ferred to be implemented by all researchers, because differ -
ent results may be produced if different protocols are
followed (Gbrich, 2007).
Regarding the data analysis process, different research
approaches can be compared based on aspects such as
“description and interpretation,” “modalities of approaches,”
“consideration of context of data,” “data analysis process,”
and “evaluation of the analysis process.”
Description and interpretation
When using content analysis, the primary aim is to describe
the phenomenon in a conceptual form (Elo & Kyngäs, 2008).
The content analyst views data as representations not of
physical events but of texts, images, and expressions created
to be seen, read, interpreted, and acted on for their meanings,
and must therefore be analyzed with such uses in mind

(Krippendorff, 2004). However, it has been claimed that
content analysis in nursing research can be applied to various
levels of interpretation (Graneheim & Lundman, 2004). In
contrast, thematic analysis applies minimal description to
data sets, and interprets various aspects of the research topic
Modalities of approaches
The current application of both content analysis and the-
matic analysis similarly, is associated with two modalities:
inductive and deductive. Inductive content analysis and the-
matic analysis is used in cases where there are no previous
studies dealing with the phenomenon, and therefore the
coded categories are derived directly from the text data
(Hsieh & Shannon, 2005). A deductive approach is useful if
the general aim of thematic analysis and content analysis is to
test a previous theory in a different situation, or to compare
categories at different periods (Hsieh & Shannon, 2005;
Elo & Kyngäs, 2008). This form tends to provide a less rich
description of the data overall, and a more detailed analysis
of some aspect of the data (Braun & Clarke, 2006). It should
be noted that both the approaches may begin with a theory
about the target phenomenon or a framework for collecting
or analysing data, but that does not mean there is a commit-
ment to stay within this theory or framework (Sandelowski,
2010). The question of whether a study needs to use an induc-
tive or directed approach can be answered in both methods
by matching the specific research purpose and the state of
science in the area of interest to the appropriate analysis
technique (Hsieh & Shannon, 2005).
Consideration of context of data
Every analysis requires a context within which the available

texts are examined. The researcher must construct a world in
which the texts make sense allowing them to answer research
questions (Krippendorff, 2004). The researcher, who has a
broader understanding of the context influencing the stories
of the study participants, may develop a wider understanding
of what is going on, in addition to the understanding that
she or he may share with those participating in the re-
search (Downe-Wamboldt, 1992). Both approaches provide
researchers with a framework of analysis within which the
context of data is apparent. Certainly, content analysis makes
sense of what is mediated between people including textual
matter, symbols, messages, information, mass-media content,
and technology supported social interactions (Krippendorff,
2004; Hsieh & Shannon, 2005). On the other hand, thematic
analysis is able to offer the systematic element characteristic
of content analysis, and also permits the researcher to
combine analysis of their meaning within their particular
context (Loffe & Yardley, 2004).
If in content analysis only the frequency of codes is
counted to find significant meanings in the text, there is the
danger of missing the context (Morgan, 1993). Therefore,
researchers employing content analysis are sometimes
accused of removing meaning from its context. The problem
is that a word or coding category may occur more frequently
in the speech of one person or group of people than another
for different reasons. Frequent occurrence could indicate
greater importance, but it might simply reflect greater will -
ingness or ability to talk at length about the topic (Loffe &
Yardley, 2004; Shields & Twycross, 2008).
Data analysis process
Like other qualitative methods, gathering and analysing
data are conducted concurrently in descriptive qualitative
approaches, thus adding to the depth and quality of data

analysis. However, it is also common to collect all the
data before examining it to determine what it reveals
(Chamberlain et al., 2004).
The process of data analysis in content analysis according
to Elo and Kyngäs (2008), and in thematic analysis according
to Braun and Clarke (2006) is shown in Table 1. According to
the table, the preparation phase in content analysis and the
phase of familiarizing with data in thematic analysis are
equivalent. In both phases, the researcher is expected to tran-
scribe the interview, and obtain the sense of the whole
through reading the transcripts several times. While the the-
matic analysis researcher is mainly advised to consider both
latent and manifest content in data analysis, the content
analyst can choose between manifest (developing categories)
and latent contents (developing themes) before proceed-
ing to the next stage of data analysis. Open coding,
collecting codes under potential subcategories/subthemes or
categories/themes, and comparing the emerged coding’s clus-
ters together and in relation to the entire data set conprise
the next stage of data analysis, which is named the organizing
phase in content analysis. The same set of analytical interven-
tions used in content analysis is applied in thematic analysis
under the classifications of generating initial codes, defining
and naming themes, reviewing themes, and searching for
themes.
The final stage of data analysis in both approaches is
related to reporting the result of the previous stages. This

stage is especially highlighted as the final opportunity of data
analysis in thematic analysis. In addition, in both approaches,
the creativity of the researcher for presenting the result in
terms of a story line, a map, or model is encouraged.
It is noted that in both approaches, high quality data analy-
sis depends on gathering high quality data. It is the respon-
sibility of researchers to conduct data gathering in such a way
that any complex data would be suitable to present interest-
ing findings. After data gathering and transcribing and paying
particular attention to respondents’ emotions besides their
behaviours, it is recommended that the data analyst immerses
himself/herself in data in order to obtain the sense of the
whole through reading and rereading (Polit & Beck, 2003).
As mentioned previously, there are many similarities
between the processes of data analysis presented at the dif-
ferent stages. The terminology used during the data analysis
process in the approaches is comparable and equivalent to
each other (Table 1). Data corpus, data item, data extract,
code, and theme in thematic analysis are equivalent in
content analysis to the unit of analysis, meaning unit, con-
densed meaning unit, code, and category/theme, respectively
(Graneheim & Lundman, 2004; Braun & Clarke, 2006; Elo &
Kyngäs, 2008).
The final product of analysis, namely the tool for present-
ing findings, is much debated in both content and thematic
analyses. At the most abstract level, emergence of the theme/
themes can be considered to be the result or final product of
data analysis. The term theme has been associated with many
definitions and is used interchangeably with a vast number
of other terms such as category, domain, unit of analysis,
phase, process, consequence, and strategy (DeSantis & Noel
Ugarriza, 2000). In this respect, there is considerable diver-

sity in nursing and qualitative research literature associated
with the identification of themes, the interpretation of the
concept, and its function in data analysis (DeSantis & Noel
Ugarriza, 2000). A theme is defined as a coherent integration
of the disparate pieces of data that constitute the findings
(Sandelowski & Leeman, 2012). It captures something
important about data in relation to the research question, and
represents some level of response pattern or meaning within
the data set (Braun & Clarke, 2006). A pragmatic way to state
the difference between a theme and a category is that the
latter refers mainly to a descriptive level of content and can
thus be seen as an expression of the manifest content of the
text, whilst the former is the expression of the latent content
(Graneheim & Lundman, 2004). Especially in thematic
analysis, themes are usually quite abstract, and therefore
difficult to identify (DeSantis & Noel Ugarriza, 2000;
Spencer et al., 2003). Furthermore, in thematic analysis the
Table 1. Processes of data analysis in thematic analysis and
qualitative content analysis
Analysis phases and their descriptions
Thematic analysis (Braun & Clarke, 2006: 87) Content analysis
(Elo & Kyngäs, 2008: 110)
Familiarising with data
Transcribing data, reading and rereading the data, noting down
initial ideas.
Preparation
Being immersed in the data and obtaining the sense of whole,
selecting the unit of analysis, deciding on the analysis of
manifest

content or latent content.
Generating initial codes
Coding interesting features of the data systematically across the
entire data set, collating data relevant to each code.
Searching for themes
Collating codes into potential themes, gathering all data
relevant to
each potential theme.
Reviewing themes
Checking if the themes work in relation to the coded extracts
and
the entire data set, generating a thematic map.
Defining and naming themes
Ongoing analysis for refining the specifics of each theme and
the
overall story that the analysis tells, generating clear definitions
and names for each theme.
Organising
Open coding and creating categories, grouping codes under
higher
order headings, formulating a general description of the
research
topic through generating categories and subcategories as
abstracting.
Producing the report
The final opportunity for analysis. Selection of vivid,
compelling

extract examples, final analysis of selected extracts, relating
back
of the analysis to the research question and literature, producing
a report of the analysis.
Reporting
Reporting the analysing process and the results through models,
conceptual systems, conceptual map or categories, and a story
line.
importance of a theme is not necessarily dependent on quan-
tifiable measures, but rather on whether it captures some-
thing important in relation to the overall research question
(Spencer et al., 2003; Braun & Clarke, 2006). The latter per -
spective is different from the current idea in content analysis,
where it is possible to reach a theme based on the frequency
of its occurrence in the text. This approach is objective, sys -
tematic, and concerned with the surface meaning of the docu-
ment rather than hidden agenda (Bloor & Wood, 2006).
One of the first decisions that should be taken when con-
ducting content analysis is whether to concentrate analysis
on the manifest or latent content of data. It is said that both
manifest and latent content deal with interpretation, but
the interpretation varies in depth and level of abstraction
(Graneheim & Lundman, 2004; Powers & Knapp, 2006). In
contrast, thematic analysis incorporates both manifest and
latent aspects. It means that the analysis of latent content of
data is an inseparable part of the manifest analysis approach

Another characteristic of data analysis in thematic analysis
is drawing a thematic map. This refers to the visual presenta-
tion of themes, codes, and their relationships, involving a
detailed account and description of each theme, their criteria,
exemplars and counter examples, and other similar details. As
one part of data analysis, it helps with reviewing themes and
achieving the aim of identifying coherent but distinctive
themes (Ryan & Bernard, 2000; Braun & Clarke, 2006). It
should not be forgotten that data analysis processes in both
approaches are not linear, simply moving from one phase to
another phase, but should be recursive with frequent reviews.
In addition, the result should be the identification of a story,
which the researcher tells about the data in relation to the
research question or questions.
Evaluation of the analysis process
Evaluating the validity or rigour of a qualitative study
requires reviewers to distinguish between researchers’ errors
during data analysis (Sandelowski & Barroso, 2003a). One
criticism that has been leveled in all qualitative approaches is
that they lack the scientific rigour and credibility associated
with traditionally accepted quantitative methods. It means
that the quantitative inquiry is assumed to occur within a
value-free framework and which rely on the measurement
and analysis of causal relationships between variables
(Horsburgh, 2003). Scientific qualitative research must yield
valid results, in the sense that the research effort is open for
careful scrutiny and it should be possible for any resulting
claims to be upheld in the face of independently available
evidence (Krippendorff, 2004). As an unavoidable part of all
qualitative approaches, both researchers and readers should
be helped to look for alternative interpretations. Credibility,
dependability, confirmability, and transferability are the most

common measures to achieve rigour in qualitative studies
(Lincoln & Guba, 1985). Although the assessment of rigour
in content and thematic analysis shares many similarities,
some differences emphasize the separate and unique identi -
ties of each approach. For instance, intercoder reliability
(analogous to interrater reliability) refers to the extent to
which more than one coder independently classifies material
in the same way as peer researchers. It is commonly used in
content analysis and has been introduced as a measure for
improving the approach’s reliability (Cavanagh, 1997).
However, because of the pure qualitative nature of thematic
analysis, peer checking of intercoder reliability is not always
possible since there is scepticism about the value of such
testing. It has been discussed that one researcher merely
trains another to think as she or he does when looking at a
fragment of text. Thus, the reliability check does not establish
that codes are objective, and merely two people can apply the
same subjective perspective to the text (Loffe & Yardley,
2004). As a practical way to improve rigour in both app-
roaches, researchers are encouraged to maintain a personal
research diary. As a word of caution, the status of these
additional materials in relation to raw data or field notes is
sometimes unclear, as is the way in which they are expected
to contribute to any interpretation. A conscious decision is
made to include and code personal memoranda alongside
field notes, and the same coding scheme is used for both types
of data (Ballinger et al., 2004; Rolfe, 2006). Finally, one of the
best ways for judging the quality of findings is whether new
insights into the studied phenomenon have been provided;
if so, the study should have increased the understanding
of particular phenomena or informed practical actions
(Krippendorff, 2004).
DISCUSSION

A comparative overview of the differences and similarities
between the approaches of content analysis and thematic
analysis was presented in order to help qualitative research-
ers choose the appropriate approach to answer their study
questions and conduct a methodologically robust study. A
limited number of publications about the two approaches
were available to be consulted for an in-depth comparison.
However, the chosen references are central to this area of
nursing research.
While the two approaches can answer the same set of
research questions, some researchers are suspicious about the
strength of both content analysis and thematic analysis in
terms of providing high quality data as exploratory qualita-
tive research. However, the authors believe that the
approaches are robust enough to be used for conducting an
introductory study on a novel phenomenon, for which the
quality of its data depends on the amount of energy and time
the researcher spends on the process of data gathering and
analysis.
Furthermore, there is a stereotype among qualitative
researchers that portrays content analysis and thematic
analysis as the easiest research approaches within qualitative
methodologies. The authors assume that as distinct and fun-
damental qualitative approaches, the two should be used by
qualitative researchers at the beginning of their research
careers. The approaches benefit from transparent structures
that, with a defined sequence of analytical stages, provide
researchers with clear and user-friendly methods for analyz-
ing data.

Although the approaches are generally considered the
most fundamental, this does not mean that they necessarily
produce simple and low quality findings. In other words, it is
possible that underlying themes/categories may not be imme-
diately apparent, but the researcher needs to be reflective,
frequently review the data from different perspectives, and
follow the stages of data analysis (DeSantis & Noel Ugarriza,
2000).
In this paper, thematic analysis was introduced as an
independent approach within the qualitative descriptive
methodologies and its differences and similarities with
content analysis were highlighted. It is emphasized that
clarifying the boundaries between qualitative approaches
may improve coherence and consistency in qualitative
research (Holloway & Todres, 2003). Following and accu-
rately describing the type of approach used in studies can
provide a universal language for nurse researchers and
strengthen the scientific base of any approach to research
(Hsieh & Shannon, 2005). In this respect, there has recently
been an effort to distinguish thematic analysis from content
analysis, its most similar qualitative research approach
(Braun & Clarke, 2006). Such a distinction between
approaches brings clarity to the data analysis process, thus
increases its rigour. An approach that is inexact and fits into
different methodologies can be seen as merely a tool
(Graneheim & Lundman, 2004). It is important for nurse
researchers to delineate and recognize the characteristics of
the approach they are going to use in their studies before
beginning data analysis (Hsieh & Shannon, 2005).
CONCLUSION
Only a few papers are available in the nursing literature to

introduce content analysis and thematic analysis. Therefore, it
can be concluded that the approaches have not been com-
pletely described, and there are many unanswered questions
about them. Moreover, both these research approaches
should be clarified in relation to their epistemological roots
and connections, which may settle researchers’ debates on
the meta-language and meaning of category and theme, and
also result in their development of the qualitative research
tradition.
In the field of qualitative research, there are overlaps
between content analysis and thematic analysis. Thematic
analysis is widely used, but there is no clear agreement
about what thematic analysis is and how researchers should
go about conducting it. Therefore, comparing the approach
with content analysis, which is more familiar to nurse
researchers may prove helpful in enhancing our under-
standing of it and defending it as a research approach in its
own right.
In summary, in spite of many similarities between content
and thematic analysis, for instance cutting across data, and
searching for patterns and themes, their main difference lies
in the possibility of quantification of data in content analysis
by measuring the frequency of different categories and
themes, which cautiously may stand as a proxy for signifi-
cance. Thus, nursing researchers must address the specific
characteristics, differences, and similarities between content
and thematic analysis to choose the appropriate research
approach.
ACKNOWLEDGMENTS
University of Swansea, United Kingdom and University of
Eastern Finland, Kuopio campus, Finland provided both

financial support and facilities to make conducting this schol -
arly research project possible. Moreover, the authors would
like to sincerely thank Immy Holloway, Professor Emeritus
in the School of Health and Social Care at Bournemouth
University, United Kingdom for her precious scientific
support and comments throughout the review process.
CONTRIBUTIONS
Conception, Design and Drafting: MV, HT, and TB.
Critical Revisions and Final Document: HT and TB.
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Research Article
Cultural Adaptation of Interventions
in Real Practice Settings
Flavio F. Marsiglia1 and Jamie M. Booth2
Abstract
This article provides an overview of some common chall enges
and opportunities related to cultural adaptation of behavioral
interventions. Cultural adaptation is presented as a necessary
action to ponder when considering the adoption of an evidence-
based
intervention with ethnic and other minority groups. It proposes
a roadmap to choose existing interventions and a specific

approach
to evaluate prevention and treatment interventions for cultural
relevancy. An approach to conducting cultural adaptations is
proposed, followed by an outline of a cultural adaptation
protocol. A case study is presented, and lessons learned are
shared as
well as recommendations for culturally grounded social work
practice.
Keywords
evidence-based practice, literature
Culture influences the way in which individuals see themselves
and their environment at every level of the ecological system
(Greene & Lee, 2002). Cultural groups are living organisms
with members exhibiting different levels of identification with
their common culture and are impacted by other intersecting
identities. Because culture is fluid and ever changing, the
process
of cultural adaptation is complex and dynamic. Social work and
other helping professions have attempted over time to integrate
culture of origin into the interventions applied with ethnic
minorities and other vulnerable communities in the United
States and globally (Sue, Arredondo, & McDavis, 1992). In
an ever-changing cultural landscape, there is a renewed need

to examine social work education and the interventions social
workers implement with cultural diverse communities.
Culturally competent social work practice is well established
in the profession and it is rooted in core social work practice
principles (i.e., client centered and strengths based). It strives
to work within a client’s cultural context to address risks and
protective factors. Cultural competency is a social work ethical
mandate and has the potential for increasing the effectiveness
of interventions by integrating the clients’ unique cultural
assets
(Jani, Ortiz, & Aranda, 2008). Culturally competent or
culturally
grounded social work incorporates culturally based values,
norms, and diverse ways of knowing (Kumpfer, Alvarado,
Smith, & Bellamy, 2002; Morano & Bravo, 2002).
Despite the awareness about the importance of implementing
culturally competent approaches, practitioners often struggle
with how to integrate the client’s worldview and the application
of evidence-based practices (EBPs). When selecting and

implementing social work interventions, practitioners often
continue to unconsciously place themselves at the center of
the provider–consumer relationship. Being unaware of their
power in the relationship and undervaluing the clients per -
spective in the selection of EBPs tends to result in a type
of social work practice that is culturally incompetent and
nonefficacious (Kirmayer, 2012). This ineffectiveness can
be experienced and interpreted by practitioners in several
ways. In instances when clients do not conform to the content
and format of existing interventions, they are easily labeled as
being resistant to treatment (Lee, 2010). In other cases, when
clients fail to adapt to a given intervention that does not feel
comfortable to them, the relationship is terminated or the
client simply does not return to services. Thus, terms such
as noncompliance and nonadherence may hide deeper issues
related to cultural mismatch or a lack of cultural competency
in the part of the practitioner.
Culturally grounded social work challenges practitioners to

see themselves as the other and to recognize that the responsi -
bility of cultural adaptation resides not solely on the clients but
involves everyone in the relationship (Marsiglia & Kulis,
2009). In order to do this, practitioners need to have acces s
to interventions or tools that are consistent with the culturally
grounded approach. A culturally grounded approach starts with
assessing the appropriateness of existing evidence-based inter-
ventions and adapting when necessary, so that they are more
1
Southwest Interdisciplinary Research Center (SIRC), School of
Social Work,
Arizona State University, Phoenix, AZ, USA
2 School of Social Work, University of Pittsburgh, Pittsburgh,
PA, USA
Corresponding Author:
Jamie M. Booth, School of Social Work, University of
Pittsburgh, 2117
Cathedral of Learning, 4200 Fifth Avenue, Pittsburgh, PA
15260, USA.
Email: [email protected]
Research on Social Work Practice
2015, Vol. 25(4) 423-432

ª The Author(s) 2014
Reprints and permission:
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DOI: 10.1177/1049731514535989
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relevant and engaging to clients from diverse cultural back-
grounds, without compromising their effectiveness. This process
of assessment, refinement, and adaptation of interventions will
lead to a more equitable and productive helping relationship.
The ecological systems approach provides a structure for
understanding the importance of cultural adaptation in social
work practice. Situated on the outer level (macro level) of
the ecological system, culture frames the norms, values, and
behaviors that operate on every other level: individual beliefs
and behaviors (micro level), family customs and communica-
tion patterns (mezzo level), and how that individual perceives
and interacts with the larger structures (exo level), such as

the school system or local law enforcement (Szapocznik &
Coatsworth, 1999). In this approach, the relationships between
individuals, institutions, and the larger cultural context within
the ecological framework are bidirectional, creating a dynamic
and rapidly evolving system (Bronfenbrenner, 1977; Gitterman,
2009). The bidirectional nature of relationships is an important
concept to consider when discussing the cultural adaptation
of social work interventions for two reasons: (1) regardless
of the setting, in social work practice, the clients and the
social workers engage in work partnerships in which both par-
ties must adapt to achieve a point of mutual understanding and
communication and (2) culture is in constant flux, as individ-
uals interact with actors and institutions which either maintain
or shift cultural norms and values over time.
Although culturally tailoring prevention and treatment
approaches to fit every individual may not be feasible, cultu-
rally grounded social work may require the adaptation of
existing interventions when necessary while maintaining the

fidelity or scientific merit of the original evidence-based
intervention (Sanders, 2000). This article discusses the need
for cultural adaptation, presents a model of adaptation from
an ecological perspective, and reviews the adaptations con-
ducted by the Southwest Interdisciplinary Research Center
(SICR) as a case study. The recommendations section con-
nects the premises of this article with the existing literature
on cultural adaptation and identifies some specific unresolved
challenges that need to be addressed in future research.
Empirically Supported Interventions (ESIs) in
Social Work Practice
EBP has become the gold standard in social work practice and
involve the ‘‘conscientious’’ and ‘‘judicious’’ application of
the best research available in practice (Sackett, 1997, p. 2).
It is commonly believed that utilizing EBP simply requires the
practitioner to locate interventions that have been rigorously
tested using scientific methods, impleme nt them, and evaluate
their effect; however, EBP acknowledges the role of individ-
uals and relationships in this process. EBP requires the inte-

gration of evidence and scientific methods with practice
wisdom, the worldview of the practitioner, and the client’s
perspectives and values (Howard, McMillen, & Pollio, 2003;
Regehr, Stern, & Shlonsky, 2007). The clinician’s judgment and
the client’s perspective are not only utilized in the selection of
the EBP intervention; they are also influential in how the inter-
vention is applied within the context of the clinical interaction
(Straus & McAlister, 2000). Achieving a balance between both
the client and the practitioner’s perspective in the application of
ESIs is essential for bridging the gap between research and
prac-
tice (Howard et al., 2003). However, the inclusion of the clini -
cian’s judgment and the client’s history potentially muddles
the scientific merit of the intervention being implemented. This
is the fundamental tension and challenge when implementing
EBP and a key reason why the gap between research and prac-
tice exists (Regehr et al., 2007).
The attraction of EBP is clear; locating and potentially

utilizing empirically tested treatment and prevention inter -
ventions allow social workers to feel more confident that they
will achieve the desired outcomes and provide clients with
the best possible treatment, thereby fulfilling their ethical
responsibility (Gilgun, 2005). Despite this clear rationale, the
utilization of EBP is limited (Mullen & Bacon, 2006) and
when it is applied, research-supported interventions may not
be implemented in the manner the authors of the intervention
intended.
This lack of treatment fidelity when implementing EBP
may be due to practitioner’s awareness that the evidence
generated by randomized control trials (RCTs) may not be
applicable to the diverse needs of their clients or adequately
address the complexity of the clients’ life (Webb, 2001;
Witkin, 1998). Practitioners have natural tendency to adapt
interventions to better fit their clients (Kumpfer et al.,
2002). Some adaptations are made consciously, but others are
made quickly during the course of implementation and based

on clinical judgment (Bridge, Massie, & Mills, 2008; Castro,
Barrera, & Martinez, 2004). ESIs, however, can only be
expected to achieve the same results as those observed when
originally tested, if they are implemented with fidelity or
strict adherence to the program structure, content, and dosage
(Dumas, Lynch, Laughlin, Phillips Smith, & Prinz, 2001;
Solomon, Card, & Malow, 2006). Although adaptations are
typically made in response to a perceived need, when they
are not done systematically, based on evidence and with the
core elements of the intervention preserved, the efficacy that
was previously achieved in the more controlled environment
may not be replicated (Kumpfer et al., 2002). Informal adap-
tation has the potential for compromising the integrity of
the original intervention, thus negating the value of the accu-
mulated evidence that supports the intervention’s effective-
ness. This tension between fidelity and fit has generated a
need for strategies to create fit while insuring fidelity.
Cultural Adaptation

The primacy of scientific rigor over cultural congruence may
be a limitation in applying ESIs and a standard that should not
be maintained in culturally competent social work practice.
When working with real communities, both must be satisfied
to the highest degree possible (Regehr et al., 2007). One solu-
tion to tension between using culturally relevant practices and
424 Research on Social Work Practice 25(4)
ESIs is locating interventions that have been designed for and
tested with a given cultural group. However, the limited avail-
ability of culturally specific interventions with strong empiri -
cal support may create barriers to this approach. Despite the
progress that has been made to date, most ESIs are developed
for and tested with middle-class White Americans, with the
assumption that evidence of efficacy with this group can be
transferred to nonmajority cultures, which may or may not
be the case (Kumpfer et al., 2002).
For example, a prevention intervention with Latino parents

found that assimilated, highly educated Latino parents were
responsive to the prevention interventions presented to them,
while immigrant parents with less education were less likely
to benefit (Dumka, Lopez, & Jacobs-Carter, 2002). This high-
lights the differential effects of an intervention based on culture
as well as a clear need for a more culturally relevant interven-
tion for immigrant parents. Despite a clear need for adaptation
in some circumstances, there is a strong risk of compromising
the effectiveness of the ESI when unstructured cultural adapta-
tions are implemented in response to perceived cultural incon-
gruence (Kirk & Reid, 2002; Kumpfer & Kaftarian, 2000;
Miller, Wilbourne, & Hettema, 2003; Solomon et al., 2006).
For that reason, when culturally and contextually specific inter-
ventions exist with strong evidence, it is certainly preferable to
select that intervention; however, in the absence of an ESI
designed and tested for the population being served, adaptation
may be a more viable and cost-effective option for scientifi-
cally merging a client’s cultural perspectives/values and the

ESI (Howard et al., 2003; Steiker et al., 2008). Systematically
adapting an intervention may increase the odds that the treat-
ment will achieve similar results than those found in more
controlled environments by minimizing the amount of sponta-
neous adaptations that the practitioner feels that they must
make to communicate within the client cultural frame
(Ferrer-Wreder, Sundell, & Mansoory, 2012).
Cultural adaptation may not only preserve the ESI’s effi-
cacy but also enhance the results attained in clinical trials
(Kelly et al., 2000). Culturally adapted interventions have the
potential to improve both client engagement in treatment and
outcomes and might be indicated when either rates fall below
what could be expected based on previous evidence (Lau,
2006). In an evaluation of a culturally adapted version of
the Strengthening Families intervention, there was a 40%
increase in program retention in the culturally adapted version
of the intervention (Kumpfer et al., 2002). Although outcomes
were not found to be significantly better in the adapted version
of the intervention, the increase in retention is a significant

improvement. Improving retention expands the intervention’s
potential to reach and impact individuals who would not
typically remain in treatment. Despite the lack of difference
in outcomes in the Strengthening Families intervention, some
evidence has emerged that culturally adapted interventions
not only increase retention but are also more effective. In a
recent meta-analysis, culturally adapted treatments had a
greater impact than standard treatments, produced better out-
comes, and were most successful when they were culturally
tailored to a single ethnic minority group (Smith, Domenech
Rodrı́guez, & Bernal, 2010).
Adapting interventions in partnership with communities also
enhances the community’s commitment to the implementation
and the chances that the program will be sustained overtime
(Castro et al., 2004). For example, efforts to adapt HIV pre-
vention programs by modifying the messages and protocols
in order for them to sound and feel natural or familiar intellec -
tually and emotionally to individuals, families, groups, and

communities have improved the communities’ receptiveness,
retention, outcomes, and overall satisfaction, in addition to
retaining high levels of fidelity (Kirby, 2002; Raj, Amaro,
& Reed, 2001; Wilson & Miller, 2003).
Finally, cultural adaptation is advantageous because it
allows the social worker to address culturally specific risk
factors and build on identified protective factors. In the case
of Latino families, differential rates of acculturation between
parents and youth appear to be a risk factor for substance use
and delinquency among youth, indicating that family-based
interventions may be the most culturally relevant intervention
(Martinez, 2006). In addition to a source of risk, cultural
norms that place a high value on family loyalty are protective
factors against a variety of negative outcomes (German,
Gonzales, & Dumka, 2009; Marsiglia, Nagoshi, Parsai, &
Castro, 2012). Identifying risk and protective factors unique
to a community and addressing these within an intervention
have the potential to increase the efficacy of the intervention.

The importance of EBP and culturally competent practice
has created tension in the field of social work. Evidence
has landed support to both claims: (1) interventions are more
effective when implemented with fidelity (Durlak & DuPre,
2008) and (2) interventions are more effective when they are
culturally adapted because they ensure a good fit (Jani et al.,
2008). These different perspectives highlight the tension in
the field between implementing manualized interventions
exactly as they were written versus to adjusting them to fit the
targeted population or community (Norcross, Beutler, &
Levant, 2006). Although this debate is far from resolved, the-
ories of adaptation have been developed that allow the
researcher/practitioner to adjust the fit without compromising
the integrity of the intervention (Ferrer-Wreder et al., 2012).
If the cultural adaptation is done systematically, it has the
potential for maximizing the benefit of the fit, as well as the
benefit of the ESI, thus providing a strategy that addresses
many of the concerns surrounding EBP’s applicability in

social work practice (Castro et al., 2004).
An Emerging Roadmap for Cultural Adaptation
Cultural adaptation is an emerging science that aims at
addressing these challenges and opportunities to enhance the
effectiveness of interventions by grounding them in the lived
experience of the participants. Strategies and processes to sys -
tematically adapt interventions while insuring a more optimal
cultural fit without compromising the integrity of scientific
merit have been proposed and are beginning to be tested
Marsiglia and Booth 425
(La Roche & Christopher, 2009). The first step in all adaptation
models is determining that the cultural adaptation of an
interven-
tion should be perused. Adaptation of an ESI is indicated when
(1) a client’s engagement in services falls below what is
expected, (2) expected outcomes are not achieved, and (3) iden-
tified culturally specific risks and/or protective factors need to

be incorporated into the intervention (Barrera & Castro, 2006).
Once the determination is made to conduct an adaptation,
there are a variety of models that one could follow all of which
fall into two categories: content and process (Ferrer-Wreder
et al., 2012). Although most current adaptation models have
merged the discussions regarding the content that should be
modified and process by which this modification takes place,
it is useful to consider them separately.
Content models identify an array of domains that may be
crucial to address when conducting an adaptation. The ecolo-
gical validity model, for example, focuses on eight dimensions
of culture: language, persons, metaphors, content, concepts,
goals, methods, and social context (Bernal, Jiménez-Chafey,
& Domenech Rodrı́guez, 2009). The cultural sensitivity model,
also a content model, identifies two distinct content areas: deep
culture, which includes aspects of culture such as thought pat-
terns, value systems, and norms, and surface culture, which
refers
to elements, such as language, food, and customs (Resnicow,

Soler, Braithwaite, Ahluwailia, & Butler, 2000). Proponents of
the cultural sensitivity model argue that both aspects of culture
should be assessed and potentially addressed if areas of conflict
or incongruence between the culture and the intervention are
identified (Resnicow et al., 2000). Surface adaptations allow the
participants to identify with the messages, potentially enhancing
engagement; while, deep culture adaptations ensure that the
outcomes are impacted (Resnicow et al., 2000).
Castro, Barrera, and Martinez (2004) and Castro, Barrera,
and Steiker, 2010 have proposed a content model that identifie s
a set of specific dimensions—at the surface and deep levels—
that are essential to consider in the adaptation process: cogni -
tive, affective, and environmental. Cognitive adaptations are
considered when participants cannot understand the content
that is being presented due to language barriers or the use of
information that is not relevant in an individual’s cultural
frame. Vignettes given by the original intervention, for exam-
ple, may not be relevant to the participants or may be offensive

due to spiritual or religious taboos. The content may create a
negative reaction from the participants which in turn may block
their ability to hear and integrate the message. It is that content
that needs to be modified while the core elements of the inter-
vention are respected. Affective-motivational adaptations are
indicated when program messages are contrary to cultural
norms and values, creating a resistance to change within the
individual (Castro, Rawson, & Obert, 2001). Environmental
factors (later referred to as relevance) make sure that the con-
tents and structure are applicable to the participants in their
daily lived experience (Castro et al., 2010).
While content models of adaptation tell adaptors where to
look for cultural mismatch, process models provide a frame-
work for making systematic assessments of cultural match,
adjustments to the original intervention, and tests of the adap-
tations effectiveness. At a minimum adaption process, models
follow two systematic steps: (1) identifying mismatches
between the original intervention and the client’s culture and

(2) testing/evaluating changes that have been made to rectify
these disparities (Ferrer-Wreder et al., 2012).
Most process models of adaptation begin with building a
partnership or coalition with members of targeted community
(Castro et al., 2010; Harris et al., 2001; Wingood & DiCle-
mente, 2008). Sometimes the ESI that will be adapted is
selected at this stage; however, more information is often gath-
ered about the targeted population before selecting the inter-
vention that would provide the best fit (Kumpfer, Pinyuchon,
Teixeriade de Melo, & Whiteside, 2008; Mckleroy et al.,
2006; Wingood & DiClemente, 2008). Whether the interven-
tion has yet to be selected, extensive formative research is con-
ducted to assess the etiology of the social problem that is the
target of the intervention, possible population-specific risks
and protective factors, and measurement equivalence to insure
and accurate evaluation of intervention outcomes (Harris et al.,
2001). Some information about the target community may be
gained by reviewing relevant literature; however, interviews,

focus groups, and surveys are also used to collect primary data
about the social and cultural context that may impact the out-
come of the intervention or conflict with the program’s mes-
sages/implementation strategies.
At this point in the process, some adaptation models recom-
mend making changes based on the formative research
(Domenech-Rodriguez & Wieling, 2004; Harris et al., 2001),
while
others suggest implementing the intervention with minimal
changes and assessing the need for further adaption. In an
innova-
tive approach, the Planned Intervention Adaptation model
suggests
making significant changes to one version of the intervention
while making minimal changes to another and implementing
them
both simultaneously to test the differential effects (Castro et al.,
2010; Ferrer-Wreder et al., 2012; Kumpfer et al., 2008).
Regardless of the level of adaptation, the modified inter-
vention is pilot tested and based on the outcomes subsequent

adaptations are made (Ferrer-Wreder et al., 2012). Once a
final adaptation has been made, further testing takes place
in effectiveness trials. Across all theories of adaptation, the
process is iterative with refinements made to the intervention
at every stage based on the evidence generated in the prior
stage (Domenech-Rodriguez & Wieling, 2004). Regardless
of the depth of changes made, the adapted intervention must
be rigorously tested to ensure that the effects of the original
ESI are preserved after changes have been made.
Case Study: Adaptations of Keepin’it REAL
(KiR), the Southwest Interdisciplinary
Research Center (SIRC) Approach
Over the past 10 years of health disparities research, the SIRC
has developed a process of cultural adaptation that includes
most of the elements outlined previously. The specific
426 Research on Social Work Practice 25(4)
adaptation model utilized at SIRC is an expanded version
of the Barrera and Castro (2006) model as illustrated by

Figure 1.
KiR is the flagship empirically supported treatment SIRC
(Marsiglia & Hecht, 2005). KiR is a manualized school-
based substance abuse prevention program for middle school
students. It was designed to (a) increase drug resistance skills
among middle school students, (b) promote antisubstance use
norms and attitudes, and (c) develop effective drug resistance
and communication skills (Gosin, Dustman, Drapeau, &
Harthun, 2003). It was created and evaluated in Arizona
through many years of community-based research funded by
the National Institutes on Drug Abuse of the National Insti -
tutes of Health. It is a model program listed under Substance
Abuse and Mental Health Services Administration’s National
Registry of Evidence-Based Programs and Practices. There is
strong evidence about the efficacy of the intervention with
middle school Mexican American students (Marsiglia, Kulis,
Wagstaff, Elek, & Dran, 2005), however the community-
identified need to reach out to younger students and to stu-

dents of other ethnic groups generated a set of adaptation
efforts summarized in Figure 2.
As Figure 2 illustrates, KiR was adapted for fifth-grade stu-
dents (Harthun, Dustman, Reeves, Marsiglia, & Hecht, 2009)
following the SIRC adaptation model and an RCT was con-
ducted to test whether the effects of the intervention increased
by intervening earlier (fifth grade vs. seventh grade). Students
who received the intervention in both the fifth and seventh
grade were no different in their self-reported use of alcohol
and other drugs than students who received the intervention
only on the seventh grade (Marsiglia, Kulis, Yabiku, Nieri,
& Coleman, 2011). This effort did no yield the expected
results but provided evidence from a developmental perspec-
tive that starting earlier was not cost effective.
The second adaptation presented in Figure 2 was also
community-generated and supported from the evidence gath-
ered during the initial RCT of KiR. Urban American Indian
(AI) youth were not benefiting from KiR as much as other

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