Guideline Adaptation Process Research Articles

Role of the nurses in partnering with mothers to give oral medication to their hospitalised child: Modification and development of a contextualised evidence-based practice guideline.

BackgroundIn paediatric wards, children are often reluctant to receive medication from nurses and eventually it is given by the parents. It is a common practice for nurses to hand the medication to mothers to give to their children, However, it is an ‘informal’ practice and lacks evidence-based guidelines.ObjectivesTo develop a contextualised and adapted evidence-based guideline to support nurses to partner with mothers/carers so that they can safely give oral medication to their hospitalised child under the supervision of a competent nurse.MethodExisting relevant guidelines were identified through searches of bibliographic databases and websites. The AGREE II: Appraisal of Guidelines for Research and Evaluation II instrument was used to appraise the quality of the identified sources. The process of guideline adaptation recommended by the South African Guidelines Excellence project was followed, and a list of adapted recommendations was developed, aligned with the legislative and regulatory frameworks for nursing in South Africa. Accessible end user documentation was developed.ResultsSix sources were screened and three sources were found to be eligible and were subjected to full appraisal. Two guidelines and one policy document were identified as suitable for adaptation. Expert consultation confirmed that the resulting adapted guideline was sound, easy to understand, and well presented for the target audience.ConclusionThis process successfully led to the development of a modified evidence-based practice guideline to enable nurses to partner with mothers/caregivers in safely giving oral medication to their hospitalised child in lower-resourced African settings.

Adapting evidence-based clinical practice guidelines for people with attention deficit hyperactivity disorder in Saudi Arabia: process and outputs of a national initiative

BackgroundWe recently adapted the published National Institute for Health and Care Excellence (NICE) Attention deficit hyperactivity disorder (ADHD) diagnosis and management guideline to the Saudi Arabian context. It has been postulated that adaptation of evidence-based clinical practice guidelines to the local healthcare context rather than de-novo development will improve their adoption and implementation without imposing a significant burden on resources. The objective of this paper is to describe the adaptation process methodology utilized for the generation of the first national guideline for management of people with ADHD in Saudi Arabia.MethodsWe used the KSU-Modified-ADAPTE methodology for the guideline adaptation process. We describe the full process in detail including the three phases of set-up, adaptation, and finalization. The process was conducted by a multidisciplinary guideline adaptation group in addition to an external review for the clinical content and methodology.ResultsThe group adapted ten main categories of recommendations from one source CPG (NICE). The recommendations include: (i) service organisation and training, (ii) recognition, identification and referral, (iii) diagnosis, (iv) support, (v) managing ADHD, (vi) dietary advice, (vii) medication, (viii) maintenance and monitoring, (ix) adherence to treatment, and (x) review of medication and discontinuation. Several implementation tools were compiled and developed to enhance implementability including a clinical algorithm, quality measures, coding system, medication tables, translations, patient information, and online resources.ConclusionsThe finalized clinical practice guideline provides healthcare providers with applicable evidence-based guidance for the management of people with ADHD in Saudi Arabia. The project also demonstrated the effectiveness of KSU-Modified-ADAPTE, and emphasized the value of a collaborative clinical and methodological expert group for adaptation of national guidelines.

Development of the Nursing Practice Guidelines for Preventing Postoperative Pulmonary Complications using the Guideline Adaptation Process

Development of the Nursing Practice Guidelines for Preventing Postoperative Pulmonary Complications using the Guideline Adaptation Process

Variations in processes for guideline adaptation: a qualitative study of World Health Organization staff experiences in implementing guidelines

BackgroundThe World Health Organisation (WHO) publishes a large number of clinical practice and public health guidelines to promote evidence-based practice across the world. Due to the variety of health system capacities and contextual issues in different regions and countries, adapting the recommendations in the guidelines to the local situation is vital for the success of their implementation. We aim to understand the range of experiences with guideline adaptation from the perspectives of those working in WHO regional and country offices. Our findings will inform development of guidance on how to improve adaptability of WHO guidelines.MethodsA grounded theory-informed, qualitative study was carried out between March 2018 and December 2018. Seventeen semi-structured interviews were conducted with participants who included WHO guideline developers and staff in the headquarters, regional and country offices recruited from a sample of published WHO guidelines. Participants were eligible for recruitment if they had recent experience in clinical practice or public health guideline implementation. Deidentified transcripts of these interview were analysed through three cycles of coding.ResultsWe categorised the adaptation processes described by the participants into two dominant models along a spectrum of guideline adaptation processes. First, the Copy or Customise Model is a pragmatic approach of either copying or customising WHO guidelines to suit local needs. This is done by local health authorities and/or clinicians directly through consultations with WHO staff. Selections and adjustments of guideline recommendations are made according to what the implementers deemed important, feasible and applicable through the consensus discussions. Second, the Capacity Building Model focuses on WHO building local capacity in evidence synthesis methods and adaptation frameworks to support local development of a national guideline informed by international guidelines.ConclusionsIn comparing and contrasting these two models of guideline adaptation, we outline the different kinds of support from WHO that may be necessary to improve the effectiveness and efficiency of the respective models. We also suggest clarifications in the descriptions of the process of guideline adaptation in WHO and academic literature, to help guideline adaptors and implementers decide on the appropriate course of action according to their specific circumstances.EthicsThis project was conducted with ethics approval from The University of Sydney (Project number: 2017/723) and WHO (Protocol ID: 00001).

An Innovative Approach to Clinical Practice Guideline Adaptation in the Nursing Profession in a Developing Country.

IntroductionHealthcare professionals should seek the necessary resources to improve the quality of care. Given the cultural, social, and economic differences, in every health care system, there are increasing needs for the adapted versions of clinical practice guidelines (CPGs). This study aimed to introduce an innovative CPG adaptation approach for nurses working in a developing country.MethodsThis study is comprised of three sections: a. An extensive systematic search of the literature, b. The adaptation process, c. Interviews, which were held with stakeholders, users and/or the target population. We applied all of the stages of guideline adaptation process according to Adaptation Resource Toolkit, with the integration of the findings of a systematic literature search and a qualitative content analysis in an “adolopted” new CPG.ResultsIn this study, we applied a mix of three methods namely adoption, adaptation and development (adolopment) of recommendations to save time, cost, and manpower efficiently. Moreover, we integrated the utilized qualitative research method and literature review with the adolopment approach to develop the recommendations.ConclusionGiven there is a paucity of nursing clinical practice guidelines (NCPGs) in the nursing management of cancer therapy-induced mucositis and to save time and costs, the findings emerging from the adoption, adaptation, and de novo guideline development by a panel of experts and qualitative content analysis (QCA) method were integrated to achieve a more comprehensive nursing practice guideline.

Evidence-based Clinical Nursing Practice Guideline for Management of Inpatient Falls: Adopting the Guideline Adaptation Process

Purpose: Despite research efforts, current fall rates are still higher than expected. To approach this problem, we developed guidelines on preventing falls in hospitals.Methods: Four guidelines were selected by the K-AGREE II process. Recommendations from each guideline were retrieved and evaluated based on the quality of evidence and the strength of the recommendations. Recommendations followed the grading system of the Korean Hospital Nurses Association’s Guideline Adaptation Manual. In the external review, 13 practice nurses from 5 hospitals and 13 panel experts including doctors, nursing managers, and pharmacists participated.Results: The final guideline consisted of 5 sections and 341 recommendations. The first two sections were composed of recommendations for institutional readiness for change process and management, and Section 3 was divided into assessment of risk factors, preventive intervention and post-fall management. The summary of falls risk factors included seven components. Multifaceted interventions were modeled into six strategies. The final sections consisted of recommendations for implementing fall improvement programs and for sustaining effective prevention programs.Conclusion: Given that falls result from various combinations of risk factors, the present guideline contains multifaceted assessments and interventions including risk-targeted strategy. This guideline will contribute to decreasing fall rates in hospitals by stimulating compliance with evidence-based practice.

Guideline adaptation in Poland: first step in evidence implementation.

According to the report published by the National Chamber of Physicians, currently the guideline development process in Poland is not coordinated and there is no document setting the standards for the process or methods of guideline production in Poland or institution assessing guideline quality on a regular basis. We postulated that adaptation of good-quality guidelines can improve the quality of the guidelines available and serve as a first step in translating evidence into practice by making physicians aware of the evidence. To discuss methodological challenges and lessons learned during the project lead by the National Chamber of Physicians regarding guideline adaptation in Poland as a first step in evidence implementation. The National Chamber of Physicians set up a project that involved adaptation of the guidelines with the use of a systematic approach suggested by the ADAPTE Collaboration. The guideline development team involved methodologist, clinical experts, specialists, primary care physician and patient representative. The process followed the framework established by the ADAPTE Toolkit. The topic in one the groups was management of depression in primary care. Key lesson learned during the process of defining clinical questions included the importance of cooperation between all involved groups due to differences in their point of views. Since several guideline documents were identified, one of the important lessons learned during the development of inclusion and exclusion criteria was to define a minimal set of methodological inclusion criteria because the documents found varied in the methods used and in the thoroughness of the description of the process. Well defined inclusion criteria, systematic use of available methods for the assessment of guideline quality and tools provided by the ADAPTE Toolkit refined to the needs of the guideline development groups facilitated the process of guideline adaptation in Poland as a first step in evidence implementation.

Application of a ventilator associated pneumonia prevention guideline and outcomes: A quasi-experimental study

ObjectiveVentilator associated pneumonia is the most frequent health-care-associated infection in Intensive Care Units, causing increased antibiotic consumption and resistance, length of stay, plus multiple health and economic costs. The aim of the study was to assess whether a customised guideline implementation would improve ventilator-associated pneumonia incidence and associated intensive care outcomes. DesignThis was a quasi-experimental, before-after study consisting of pre-intervention, intervention and post-intervention periods. SettingThree intensive care units at a well-known Portuguese hospital centre. InterventionA set of eight recommendations was implemented after a guideline adaptation process. PatientsAdult patients admitted to the intensive care units over the study periods, aged 18 years or older and under invasive ventilation through an endotracheal tube or tracheostomy cannula. Measurements and main resultsData related to patient characterisation, guideline compliance and health outcomes were analysed. From a population of 1970 patients, a study sample of 828 was studied. Compliance with the recommendations was high. We identified a significant reduction in the incidence of ventilator-associated pneumonia in two of the units (p = 0.020 and p = 0.001) and a reduction in duration of invasive ventilation, intensive care unit length of stay and mortality in all the three units. We found associations between some recommendations and the implementation of the set of recommendations and intensive care unit length of stay, duration of invasive ventilation and mortality. ConclusionThe implementation of an evidence-based, locally customised guideline may improve ventilator associated pneumonia incidence and several outcomes.

Adaptation of the 2015 American College of Rheumatology treatment guideline for rheumatoid arthritis for the Eastern Mediterranean Region: an exemplar of the GRADE Adolopment

BackgroundIt has been hypothesized that adaptation of health practice guidelines to the local setting is expected to improve their uptake and implementation while cutting on required resources. We recently adapted the published American College of Rheumatology (ACR) Rheumatoid Arthritis (RA) treatment guideline to the Eastern Mediterranean Region (EMR). The objective of this paper is to describe the process used for the adaptation of the 2015 ACR guideline on the treatment of RA for the EMR.MethodsWe used the GRADE-Adolopment methodology for the guideline adaptation process. We describe in detail how adolopment enhanced the efficiency of the following steps of the guideline adaptation process: (1) groups and roles, (2) selecting guideline topics, (3) identifying and training guideline panelists, (4) prioritizing questions and outcomes, (5) identifying, updating or conducting systematic reviews, (6) preparing GRADE evidence tables and EtD frameworks, (7) formulating and grading strength of recommendations, (8) using the GRADEpro-GDT software.ResultsThe adolopment process took 6 months from January to June 2016 with a project coordinator dedicating 40% of her time, and the two co-chairs dedicating 5% and 10% of their times respectively. In addition, a research assistant worked 60% of her time over the last 3 months of the project. We held our face-to-face panel meeting in Qatar. Our literature update included five newly published trials. The certainty of the evidence of three of the eight recommendations changed: one from moderate to very low and two from low to very low. The factors that justified a very low certainty of the evidence in the three recommendations were: serious risk of bias and very serious imprecision. The strength of five of the recommendations changed from strong to conditional. The factors that justified the conditional strength of these 5 recommendations were: cost (n = 5 [100%]), impact on health equities (n = 4 [80%]), the balance of benefits and harms (n = 1 [20%]) and acceptability (n = 1 [20%]).ConclusionThis project confirmed the feasibility of GRADE-Adolopment. It also highlighted the value of collaboration with the organization that had originally developed the treatment guideline. We discuss the implications for both guideline adaptation and future research to advance the field.

Management of convulsive status epilepticus in children: an adapted clinical practice guideline for pediatricians in Saudi Arabia.

Objective:To increase the use of evidence-based approaches in the diagnosis, investigations and treatment of Convulsive Status Epilepticus (CSE) in children in relevant care settings.Method:A Clinical Practice Guideline (CPG) adaptation group was formulated at a university hospital in Riyadh. The group utilized 2 CPG validated tools including the ADAPTE method and the AGREE II instrument.Results:The group adapted 3 main categories of recommendations from one Source CPG. The recommendations cover; (i)first-line treatment of CSE in the community; (ii)treatment of CSE in the hospital; and (iii)refractory CSE. Implementation tools were built to enhance knowledge translation of these recommendations including a clinical algorithm, audit criteria, and a computerized provider order entry.Conclusion:A clinical practice guideline for the Saudi healthcare context was formulated using a guideline adaptation process to support relevant clinicians managing CSE in children.

Korean Guidelines for Diagnosis and Management of Chronic Heart Failure.

The prevalence of heart failure (HF) is skyrocketing worldwide, and is closely associated with serious morbidity and mortality. In particular, HF is one of the main causes for the hospitalization and mortality in elderly individuals. Korea also has these epidemiological problems, and HF is responsible for huge socioeconomic burden. However, there has been no clinical guideline for HF management in Korea. The present guideline provides the first set of practical guidelines for the management of HF in Korea and was developed using the guideline adaptation process while including as many data from Korean studies as possible. The scope of the present guideline includes the definition, diagnosis, and treatment of chronic HF with reduced/preserved ejection fraction of various etiologies.

Understanding kidney care needs and implementation strategies in low- and middle-income countries: conclusions from a “Kidney Disease: Improving Global Outcomes” (KDIGO) Controversies Conference

Evidence-based cinical practice guidelines improve delivery of uniform care to patients with and at risk of developing kidney disease, thereby reducing disease burden and improving outcomes. These guidelines are not well-integrated into care delivery systems in most low- and middle-income countries (LMICs). The KDIGO Controversies Conference on Implementation Strategies in LMIC reviewed the current state of knowledge in order to define a road map to improve the implementation of guideline-based kidney care in LMICs. An international group of multidisciplinary experts in nephrology, epidemiology, health economics, implementation science, health systems, policy, and research identified key issues related to guideline implementation. The issues examined included the current kidney disease burden in the context of health systems in LMIC, arguments for developing policies to implement guideline-based care, innovations to improve kidney care, and the process of guideline adaptation to suit local needs. This executive summary serves as a resource to guide future work, including a pathway for adapting existing guidelines in different geographical regions.

Application of Agree II Instrument for Appraisal of Postpartum Hemorrhage Clinical Practice Guidelines in Bosnia and Herzegovina.

Introduction:Federal Minister of Health and Minister of Health and Social Welfare of the Republika Srpska as a Governmental health authorities in Federation of Bosnia and Herzegovina (FBiH) and the Republika Srpska nominated/appointed health professionals as their representatives to a multidisciplinary Guidelines Adaptation Group (GAG). This group started with its work in September 2015. The main purpose of the guidelines development exercise is to develop guidelines with worldwide recognized methodology for clinical guidelines development and adaptation. At the end of this consultancy, GAG would have develop a clinical practice guideline on Postpartum hemorrhage (PPH) through the adaptation method, starting from published international clinical guidelines and adapting it according to the country specific requirements.Methodology:During the process of identifying the best guideline for adaptation, the GAG had to pass several steps. One of the crucial steps was to identify the questions related to clinical practice and health policy for which answers are needed to be addressed by the guideline. These questions included relevant issues regarding the topic area such as diagnosis, prognosis, intervention, service delivery, and training. After that, six guidelines have been researched by the six members of the GAG to see if they answered the identified questions. Evaluating the methodological quality of the selected clinical guidelines was a second essential step before deciding which ones could best fit the needs and interests. AGREE II instrument has been chosen as methods for evaluating clinical guideline quality and appropriateness. Four appraisers conducted the assessment of each of the selected guidelines for PPH. All appraisers passed the training for the AGREE II instrument before conducting appraisals, as recommended by the AGREE collaboration. Each of the four guidelines was rated independently with the AGREE II tool by each appraiser.Results:The highest score was obtained by the WHO recommendations for postpartum hemorrhage guidelines and each of four assessors recommended it to be adapted and further implemented.Discussion:In spite of several serous attempts and two Agencies for quality improvement in BiH the whole process of guideline adaptation is still in the beginning and therefore the establishment of a strong connection with similar institutions and organizations from our region and the rest of the world is very important. Cooperation and collaboration across institutions and countries and key stakeholders have potential to significantly improve the validity and quality of the adapted guidelines and to positively influence implementation.

Adaptation of a Translated Guideline on Screening for Delirium, Dementia, and Depression in Older Adults

Purpose: The aim of this methodological study was translation and adaption of the evidence based guideline of the RNAO in Canada, for screening of delirium, dementia and depression in older adults. Methods: The guideline adaptation process was conducted according to the standardized methodology for nursing practice guideline adaptation developed by Korean Hospital Nurses Association. Quality of the RNAO guideline was evaluated using AGREE II tool. Then the guideline was translated into Korean and a preliminary guideline was established after appropriateness and applicability were checked by an expert group. Results: The adapted screening practice guideline consisted of 3 domains and 11 recommendations, including practice, education, organization and policy. Of the recommendations 9.1% were graded A, 27.3%, B, and 63.6%, C. Conclusion: This guideline is expected to contribute to improving nursing quality by offering it as a guide to evidence based practices for screening delir-ium, dementia and depression in Korean older adults.

Adaptation of evidence-based nursing practice guideline for central venous-port management

Background: There are some differences in the guidelines on management of central venous-port among the units in this hospital. Therefore, we developed evidence-based guidelines to improve the efficiency of nursing practice and quality of patient care. Objective: This study was conducted to develop evidence-based nursing practice guidelines on central venous-port management in Korea. Methods: Guideline adaptation process was conducted according to the evidence-based intravenous infusion nursing practice guideline (Ku mi-Oak, 2012) which was conducted previously according to the guideline adaptation manual version 2.0 developed by NECA (Kim Su Young et al, 2011). Results: The adapted evidence-based nursing practice guidelines on central venous-port management consisted of 18 domains and 94 recommendations. Some of the recommendations included sub-domains which were supported by evidence and grades. The number of recommendations with levels of evidence and gradings were 104, and they were 11.5% of I, 29.8% of II, 58.7% of III. There were 22.1% of A, 30.8% of B, 47.1% of C in the recomended grades. The grade C recommendations of evidence accounted for 47.1% of all the recommendations, which means most of the recommendations did not have enough evidence. Discussion: There are not enough experimental studies to contribute quality evidence for the core questions of the central venous-port management, and furthermore most of the recommendations are mainly from descriptive studies and expert‘s opinions. We suggest to researchers to conduct futher studies on the evidence with grade C recommendations. We need well designed experimental study, especially on the central venous-port patency and heparin locking. Conclusion: The adapted evidence-based nursing practice guidelines on central venous-port management is recommended to be disseminated to nurses on a national scale to improve the efficiency of nursing practice and the quality of patient care.

Adaptation of Trustworthy Guidelines Developed Using the GRADE Methodology: A Novel Five-Step Process

Adaptation of guidelines for use at the national or local level can facilitate their implementation. We developed and evaluated an adaptation process in adherence with standards for trustworthy guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, aiming for efficiency and transparency. This article is the first in a series describing our adaptation of Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines for a Norwegian setting. Informed by the ADAPTE framework, we developed a five-step adaptation process customized to guidelines developed using GRADE: (1) planning, (2) initial assessment of the recommendations, (3) modification, (4) publication, and (5) evaluation. We developed a taxonomy for describing how and why recommendations from the parent guideline were modified and applied a mixed-methods case study design for evaluation of the process. We published the adapted guideline in November 2013 in a novel multilayered format. The taxonomy for adaptation facilitated transparency of the modification process for both the guideline developers and the end users. We excluded 30 and modified 131 of the 333 original recommendations according to the taxonomy and developed eight new recommendations. Unforeseen obstacles related to acquiring a licensing agreement and procuring a publisher resulted in a 9-month delay. We propose modifications of the adaptation process to overcome these obstacles in the future. This case study demonstrates the feasibility of a novel guideline adaptation process. Replication is needed to further validate the usefulness of the process in increasing the organizational and methodologic efficiency of guideline adaptation.

Evaluation of the acceptability, feasibility and effectiveness of two methods of involving patients with disability in developing clinical guidelines: study protocol of a randomized pragmatic pilot trial

BackgroundDespite growing interest in the importance of, and challenges associated with the involvement of patient and population (IPP) in the process of developing and adapting clinical practice guidelines (CPGs), there is a lack of knowledge about the best method to use. This is especially problematic in the field of rehabilitation, where individuals with disabilities might face many barriers to their involvement in the guideline development and adaptation process. The goal of this pilot trial is to document the acceptability, feasibility and effectiveness of two methods of involving patients with a disability (traumatic brain injury) in CPG development.Methods/DesignA single-blind, randomized, crossover pragmatic trial will be performed with 20 patients with traumatic brain injury (TBI). They will be randomized into two groups, and each will try two alternative methods of producing recommendations; a discussion group (control intervention) and a Wiki, a webpage that can be modified by those who have access to it (experimental intervention). The participants will rate the acceptability of the two methods, and feasibility will be assessed using indicators such as the number of participants who accessed and completed the two methods, and the number of support interventions required. Twenty experts, blinded to the method of producing the recommendations, will independently rate the recommendations produced by the participants for clarity, accuracy, appropriateness and usefulness.DiscussionOur trial will allow for the use of optimal IPP methods in a larger project of adapting guidelines for the rehabilitation of individuals with TBI. Ultimately the results will inform the science of CPG development and contribute to the growing knowledge about IPP in rehabilitation settings.Trial registrationClinical trial KT Canada 87776.

Evidence-based, pharmacological treatment guideline for depression in Korea, revised edition.

This paper aims to introduce, summarize, and emphasize the importance of the 'Evidence-Based, Pharmacological Treatment Guideline for Depression in Korea, Revised Edition'. The guideline broadly covers most aspects of the pharmacological treatment of patients in Korea diagnosed with moderate to severe major depression according to the DSM-IV TR. The guideline establishment process involved determining and answering a number of key questions, searching and selecting publications, evaluating recommendations, preparing guideline drafts, undergoing external expert reviews, and obtaining approval. A guideline adaptation process was conducted for the revised edition. The guideline strongly recommends pharmacological treatment considered appropriate to the current clinical situation in Korea, and should be considered helpful when selecting the appropriate pharmacological treatment of patients diagnosed with major depressive disorder. Therefore, the wide distribution of this guideline is recommended.

Adapting lung cancer symptom investigation and referral guidelines for general practitioners in Australia: Reflections on the utility of the ADAPTE framework

The ADAPTE framework was established to enhance efficiency in guideline development and to facilitate adaptation of high-quality clinical practice guidelines for a local context. It offers guideline developers a systematic methodology for guideline adaptation; however, the feasibility and usability of the process has not been widely evaluated. A pragmatic approach was undertaken throughout the evaluation of the ADATPE process throughout the development of a guide for general practitioners in Australia regarding the initial investigation of symptoms of lung cancer. At each step of the framework all members of the project team leading the development process reflected on the steps outlined in the ADAPTE. The reflections were collated into a lesson-learned log and analysed following completion of the project. Several opportunities for improvement were identified to improve usability and practicability of the ADAPTE framework. These items were both specific, in response to using steps and tools, and general issues concerned with the overall ADAPTE framework. Key challenges to using ADAPTE, highlighted in this study, were the lack of clarity about efficiency of the guideline adaptation process, level of assumed knowledge and expertise, and requirement of resources. In response to these challenges, modifications to the ADAPTE have been recommended. The ADAPTE framework offers an attractive alternative to de novo guideline synthesis in circumstances where high-quality, compatible guidelines already exist. Pending further evaluation, the modifications identified in this study may be applied to future versions of ADAPTE to improve usability and feasibility of the framework.

Adapting low back pain guidelines within a multidisciplinary context: a process evaluation

The Alberta Ambassador Program (AAP) adapted seven clinical practice guidelines on low back pain (LBP) into a single guideline spanning the continuum of care from prevention and diagnosis through to treatment. The Ambassador adaptation process was evaluated to 1 Identify the major challenges encountered and successful strategies utilized; 2 Assess strengths and weaknesses by benchmarking it with the ADAPTE framework; and 3 Identify opportunities for improvement. External consultants reviewed the Ambassador and ADAPTE materials and conducted semi-structured telephone interviews with 29 participants from the AAP committees. All participants were asked about the major challenges encountered and potential areas for improvement. The response rate was 83% (29/35). There was strong consensus that the Ambassador guideline adaptation process was sound and rigorous all respondents indicated willingness to participate in further iterations of the Program. Key elements of success were identified. The main steps and sequence of the process were closely aligned with the ADAPTE framework, although the AAP incorporated additional enhancements which augmented the process. The main divergences between the two frameworks centred on the organizational structure and the methods used to overcome methodological difficulties. The AAP successfully utilized existing stakeholder interest to create an overarching guideline for managing LBP across multiple primary care disciplines. The study highlighted the strengths and weaknesses of the Program, and identified practical strategies for improvement. Evaluating guideline adaptation processes is pivotal to ensuring that they continue to be an efficient, rigorous and practicable option for producing contextualized, clinically relevant guidelines.