Educators are continually searching for the most effective and efficient way to support student learning and achievement. In health education, educators must address the specific need to change or modify behaviors, particularly when teaching youth about decisions regarding the use of drugs. The decision by youth to engage in risky drug behavior can have long-lasting implications for their health over a life course as well as a broader societal impact. Research-based curriculum have been proven to reduce risky behaviors in youth when implemented in schools with fidelity. However, as these curricula come in contact with the school setting, the curriculum is often adapted to fit the needs of the school and local community.

The purpose of this qualitative grounded theory study was to develop an adaptation theory through examination of the adaptations that teachers make to research-based health education curricula during implementation. Classroom observations and teacher interviews of four teachers were conducted to examine these factors. More specifically, the study examined the types of adaptations that teachers make, how and when teachers come to the decision to adapt or not adapt the curriculum, and their reasons for adaptation. In examining the adaptations that teachers made to the curriculum, teachers adapted the curriculum to comply with local policies, meet student needs, and engage students in learning. Policies related to standards and assessment, as well as academic initiatives drove adaptations. Some teachers adapted to ensure a caring, supportive environment and to engage students through a variety of learning activities. Teachers also adapted based on student needs and academic ability, as well as other unique student needs. These unique student needs included current drug use, family dynamics, or other conditions reflected in local data. Additions were the most common adaptation, with modifications less common, and omissions least common. The research-based curriculum was used as a guide for teaching, with local needs informing adaptations. The curriculum was taught with fidelity to the extent that it aligned with local needs. Teachers take the role of sense-maker, making sense of how the research-based curriculum fit into the local classroom environment and the needs of their students.