Using intervention mapping to adapt a visual-aided adolescent nutrition intervention from peri-urban Burkina Faso and operationalize implementation strategies in rural Uganda

Background: Adolescents and young adults (AYAs) in Sub-Saharan Africa (SSA), including rural Uganda, commonly experience low nutrition literacy and poor diet quality, increasing their risk of malnutrition and diet-related non-communicable diseases. Most nutrition education interventions originate from high-income or school-based contexts, limiting relevance for rural and out-of-school AYAs. Context-specific, community-anchored interventions, and guidance on how to implement them within existing health systems ‒ remain scarce. We therefore used Intervention Mapping (IM) to support a systematic South–South participatory adaptation of a visual-aided adolescent nutrition intervention from peri-urban Burkina Faso and to operationalize implementation strategies for household-level delivery in rural Uganda. Adaptation process and implementation strategies: We applied the iterative six-step IM protocol, grounded in the Socio-Ecological Model (SEM) and Social Cognitive Theory (SCT). A multi-stakeholder planning group comprising AYAs, parents, community health workers (CHWs), Government officials, and technical experts co-produced adaptations across six IM-aligned co-design workshops. A mixed-methods, SEM-guided needs assessment identified nutrition literacy, parental influence, receptiveness to CHW advice, food-related myths, and limited access to diverse foods as priority determinants of AYAs’ diet quality. Behavioural and environmental outcomes were specified, SCT-informed behaviour change methods were mapped, and translated into discrete, CHW-led implementation strategies, including training, use of visual aids, standard operating procedures–guided household visits, demonstration-based counselling, and supervision to support fidelity. Key adaptations included redesigning visual materials for low-literacy audiences, revising content to rural dietary realities, and embedding delivery within Uganda’s nationally institutionalized CHW platform. Nine visual-aided thematic flyers were produced, piloted, and refined. The process generated a rural Uganda–specific logic model of the problem, theory of change, a fully adapted intervention package, and operationalized implementation strategies for monthly CHW household delivery. Implications for implementation practice: By operationalizing implementation strategies alongside intervention adaptation, this study provides an actionable template for localizing visual-aided behaviour-change interventions within community health systems serving underserved AYAs in rural SSA, strengthening implementation readiness, fidelity, and scalability. Conclusion: A randomized controlled trial with an embedded process evaluation is underway. If effective, the operationalized CHW-led implementation strategies could support scale-up across rural Uganda and comparable SSA settings to improve AYAs’ nutrition literacy and diet quality. Trial registration: PACTR202501305580883