Background Antenatal and postnatal Group Care, based on the Centering Healthcare model, relies on three core components: health assessment, interactive learning and community building. The health assessment consists of selfassessments conducted by the participants and one-to-one medical check-ups conducted by the healthcare provider. Research shows that this component can be challenging within existing health care systems. This study aimed to investigate the modifications and corresponding strategies applied to adopt the health assessment during Group Care implementation.

Methods A qualitative descriptive study explored modifications to the health assessment and the corresponding strategies in 24 Group Care implementation sites in seven countries. A structured qualitative survey was conducted based on the Expanded Framework for Adaptations and Modifications to Evidence-Based Interventions including views of different stakeholders (site-level and project-level implementers). This provided data on the ‘who’, ‘what’, and ‘where’ of modifications and corresponding strategies. Reflexive thematic analysis provided both structured and in-depth insights into the adaptation process.

Results Three cross-country strategies were identified: (1) creative solutions to find appropriate spaces for Group Care to accommodate the health assessment, (2) providing assistance with self-assessment, (3) and extending the duration of one-to-one medical check-ups. These strategies were primarily the result of joint decisions made by the implementation team, influenced by multiple context-related factors. Different perspectives emerged regarding for whom these strategies were applied, with some stating it as being for the benefit of the participants, while others aimed to align with facilitators’ preferences and familiarity with providing routine care.