In order to meet future food demand while sustainably managing available land and water resources, irrigated agriculture in semi-arid regions needs to adapt as a response to climate and socio-economic change. In this study, we focus on the Mediterranean region, a dynamic region, which is highly dependent on irrigated agriculture. We provide insight on adaptation strategies implemented on farm level, by doing a systematic review of studies in the region. Our analysis reports 286 implemented adaptations, on 124 different locations throughout the Mediterranean. Additionally, 142 drivers and 324 effects of adaptations were noted. We identified 31 adaptation strategies in 5 main categories: (1) water management, (2) sustainable resource management, (3) technological developments, (4) farm production practices, and (5) farm management. Strategies in the categories water management and farm production practices are most often implemented by farmers in the region. The main driver in the area is water scarcity and adaptations often affected water use and resources in addition to farm practices. Subsequently, we studied the spatial context of adaptations by analyzing the location factors of the five main strategies, using Geographic Information Systems and maximum entropy modeling. Our results show that farmers are more likely to adapt in less rural areas with lower poverty values and better market access, and in areas with higher temperatures and less rainfall. This demonstrates that both biophysical and socio-economic factors determine the context in which adaptations are implemented and that considerable spatial variability in the area exists.