Abstract
BackgroundThis paper describes the process and results of a refinement of a framework to characterize modifications to interventions. The original version did not fully capture several aspects of modification and adaptation that may be important to document and report. Additionally, the earlier framework did not include a way to differentiate cultural adaptation from adaptations made for other reasons. Reporting additional elements will allow for a more precise understanding of modifications, the process of modifying or adapting, and the relationship between different forms of modification and subsequent health and implementation outcomes.DiscussionWe employed a multifaceted approach to develop the updated FRAME involving coding documents identified through a literature review, rapid coding of qualitative interviews, and a refinement process informed by multiple stakeholders. The updated FRAME expands upon Stirman et al.’s original framework by adding components of modification to report: (1) when and how in the implementation process the modification was made, (2) whether the modification was planned/proactive (i.e., an adaptation) or unplanned/reactive, (3) who determined that the modification should be made, (4) what is modified, (5) at what level of delivery the modification is made, (6) type or nature of context or content-level modifications, (7) the extent to which the modification is fidelity-consistent, and (8) the reasons for the modification, including (a) the intent or goal of the modification (e.g., to reduce costs) and (b) contextual factors that influenced the decision. Methods of using the framework to assess modifications are outlined, along with their strengths and weaknesses, and considerations for research to validate these measurement strategies.ConclusionThe updated FRAME includes consideration of when and how modifications occurred, whether it was planned or unplanned, relationship to fidelity, and reasons and goals for modification. This tool that can be used to support research on the timing, nature, goals and reasons for, and impact of modifications to evidence-based interventions.
Highlights
This paper describes the process and results of a refinement of a framework to characterize modifications to interventions
Adaptation, a key concept in implementation, has been defined as a process of thoughtful and deliberate alteration to the design or delivery of an intervention, with the goal of improving its fit or effectiveness in a given context [1, 2]. It is a form of modification, which is a broader concept that encompasses any changes made to interventions, whether deliberately and proactively, or in reaction to unanticipated challenges
Framework refinement to increase the likelihood that the updated framework would document aspects of modification and adaptation that were important to stakeholders, we presented a draft of the framework to several groups of stakeholders and solicited suggestions regarding additions, refinements, and clarifications
Summary
This paper describes the process and results of a refinement of a framework to characterize modifications to interventions. Adaptation, a key concept in implementation, has been defined as a process of thoughtful and deliberate alteration to the design or delivery of an intervention, with the goal of improving its fit or effectiveness in a given context [1, 2]. It is a form of modification, which is a broader concept that encompasses any changes made to interventions, whether deliberately and proactively (adaptation), or in reaction to unanticipated challenges. Inconsistent reporting has resulted in uncertainty regarding modification’s impact on health and the types of modifications that can maximize implementation success [15, 16]
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