The advantages and limitations of guideline adaptation frameworks

Abstract

BackgroundThe implementation of evidence-based guidelines can improve clinical and public health outcomes by helping health professionals practice in the most effective manner, as well as assisting policy-makers in designing optimal programs. Adaptation of a guideline to suit the context in which it is intended to be applied can be a key step in the implementation process. Without taking the local context into account, certain interventions recommended in evidence-based guidelines may be infeasible under local conditions. Guideline adaptation frameworks provide a systematic way of approaching adaptation, and their use may increase transparency, methodological rigor, and the quality of the adapted guideline.This paper presents a number of adaptation frameworks that are currently available. We aim to compare the advantages and limitations of their processes, methods, and resource implications. These insights into adaptation frameworks can inform the future development of guidelines and systematic methods to optimize their adaptation.AnalysisRecent adaptation frameworks show an evolution from adapting entire existing guidelines, to adapting specific recommendations extracted from an existing guideline, to constructing evidence tables for each recommendation that needs to be adapted. This is a move towards more recommendation-focused, context-specific processes and considerations. There are still many gaps in knowledge about guideline adaptation. Most of the frameworks reviewed lack any evaluation of the adaptation process and outcomes, including user satisfaction and resources expended. The validity, usability, and health impact of guidelines developed via an adaptation process have not been studied. Lastly, adaptation frameworks have not been evaluated for use in low-income countries.ConclusionDespite the limitations in frameworks, a more systematic approach to adaptation based on a framework is valuable, as it helps to ensure that the recommendations stay true to the evidence while taking local needs into account. The utilization of frameworks in the guideline implementation process can be optimized by increasing the understanding and upfront estimation of resource and time needed, capacity building in adaptation methods, and increasing the adaptability of the source recommendation document.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0763-4) contains supplementary material, which is available to authorized users.

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“…lack of consumer understanding, limited space on menus). While adaptation can be viewed as a key step in the implementation process [98,99], the risk of compromising fidelity to core intervention components and potentially reducing the effects needs to be considered [100]. Few of the included studies adequately reported on the intervention components of their menu labelling scheme; thus future studies should report on same using the TIDieR-PHP checklist [101].…”

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“…We utilised the 'KSU Modi ed ADAPTE' [9] adaptation methodology, a natural evolution of two earlier formal adaptation methodologies for CPGs, the original ADAPTE and 'Adapted ADAPTE' methods [12][13][14], which consists of three phases and 24 steps with modi cations in the steps and tools to suit the local general healthcare setting in Saudi Arabia [9,13]. Figure 1 provides a simpli ed owchart of our methods [9].…”

“…Adaptation of CPGs is a valid and e cient alternative to de novo development of CPGs especially in resourcelimited healthcare settings. It was proposed to avoid duplication of efforts, to use the available resources in a cost-effective manner, and to encourage trans-contextual customization of the CPG prepared for different economic and healthcare settings re ecting the local context and system [9][10][11][12][13].…”

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