The what, why and when of adapting interventions for new contexts: A qualitative study of researchers, funders, journal editors and practitioners’ understandings

Copeland, Lauren; Littlecott, Hannah; Couturiaux, Danielle; Hoddinott, Pat; Segrott, Jeremy; Murphy, Simon; Moore, Graham; Evans, Rhiannon Emily

doi:10.1371/journal.pone.0254020

Cited by 10 publications

(17 citation statements)

References 59 publications

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“…This study underscores the complexity of IBCM which stems from the interaction of its many components as they relate to the context or system where they are implemented (55). These findings demonstrate the importance of transferring the evidence base of the IBCM approach to inform adaptations when implemented in a new context to ensure effectiveness (56). Tools such as the ADAPT guidance provide a framework and checklist, facilitating the streamlining of these processes and reducing research waste (57).…”

Section: Discussionmentioning

confidence: 76%

Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management

et al. 2022

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As part of the ‘Zero by 30’ strategy to end human deaths from dog-mediated rabies by 2030, international organizations recommend a One Health framework that includes Integrated Bite Case Management (IBCM). However, little is understood about the implementation of IBCM in practice. This study aims to understand how IBCM is conceptualized, exploring how IBCM has been operationalized in different contexts, as well as barriers and facilitators to implementation. Semi-structured interviews were conducted with seventeen practitioners and researchers with international, national, and local expertise across Africa, Asia, and the Americas. Thematic analysis was undertaken using both inductive and deductive approaches. Four main themes were identified: 1) stakeholders’ and practitioners’ conceptualization of IBCM and its role in rabies elimination; 2) variation in how IBCM operates across different contexts; 3) barriers and facilitators of IBCM implementation in relation to risk assessment, PEP provisioning, animal investigation, One Health collaboration, and data reporting; and 4) the impact of the COVID-19 pandemic on IBCM programs. This study highlights the diversity within experts’ conceptualization of IBCM, and its operationalization. The range of perspectives revealed that there are different ways of organizing IBCM within health systems and it is not a one-size-fits-all approach. The issue of sustainability remains the greatest challenge to implementation. Contextual features of each location influenced the delivery and the potential impact of IBCM. Programs spanned from highly endemic settings with limited access to PEP charged to the patient, to low endemicity settings with a large patient load associated with free PEP policies and sensitization. In practice, IBCM was tailored to meet the demands of the local context and level of rabies control. Thus, experts’ experiences did not necessarily translate across contexts, affecting perceptions about the function, motivation for, and implementation of IBCM. To design and implement future and current programs, guidance should be provided for health workers receiving patients on assessing the history and signs of rabies in the biting animal. The study findings provide insights in relation to implementation of IBCM and how it can support programs aiming to reach the Zero by 30 goal.

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Section: Discussionmentioning

confidence: 76%

Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management

et al. 2022

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“…The ADAPT guidance was developed using a systematic review of existing guidance 13 and scoping review of adaptation studies 14 ; qualitative interviews with researchers, funders, journal editors, and policy or practice stakeholders 15 ; and a three round Delphi consensus exercise (protocol paper 16 ). Individual substudies were submitted for publication as completed, with draft guidance developed through discussion and synthesis of findings across work packages by the author group.…”

Section: How Was the Adapt Guidance Developed?mentioning

confidence: 99%

“…We illustrate recommendations with reference to several empirical examples, a broader selection of which appear in our full guidance document. 15 …”

Section: Framework and Recommendationsmentioning

confidence: 99%

“…Consistent with concerns that much existing guidance for adaptation is overly prescriptive,26 we present flexible recommendations relevant to stakeholders who might enter at different stages, and iterate between and within stages. We illustrate recommendations with reference to several empirical examples, a broader selection of which appear in our full guidance document 15…”

Section: Framework and Recommendationsmentioning

confidence: 99%

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Adapting interventions to new contexts—the ADAPT guidance

Moore

Campbell

Copeland

et al. 2021

BMJ

Self Cite

206

186

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Use of interventions with a previous evidence base in new contexts might be more efficient than developing new interventions Many population health problems and interventions are highly sensitive to context, so implementing an intervention in a new context without adaptation might be less likely to lead to positive outcomes A new consensus informed guidance for adapting interventions to achieve a good fit between the intervention and context (ADAPT) proposes systematic processes for adapting interventions to new contexts, and transparent reporting to facilitate synthesis on what does or does not workThe ADAPT guidance was developed using systematic review methods, qualitative interviews, extensive consultation, and formal consensus methods. It provides a framework and step-by-step guidance for working with stakeholders, selecting suitable interventions, undertaking adaptations, making decisions on evaluation and implementation, and reporting adapted interventions

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“…There is a growing literature describing frameworks and approaches to deploying and documenting adaptations of evidence-based practices in healthcare [6][7][8][9][10]. Yet, reporting of intervention adaptations (and their justification) is limited in detail and therefore hampers robust evaluation of intervention and adaptation effectiveness in new contexts [11,12]. This critique suggests gaps in approaches to modifying interventions for new application.…”

Section: Introductionmentioning

confidence: 99%

Adapting to CONNECT: modifying a nursing home-based team-building intervention to improve hospital care team interactions, functioning, and implementation readiness

Wang

Dadolf

Decosimo

et al. 2022

BMC Health Serv Res

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Background Clinical interventions often need to be adapted from their original design when they are applied to new settings. There is a growing literature describing frameworks and approaches to deploying and documenting adaptations of evidence-based practices in healthcare. Still, intervention modifications are often limited in detail and justification, which may prevent rigorous evaluation of interventions and intervention adaptation effectiveness in new contexts. We describe our approach in a case study, combining two complementary intervention adaptation frameworks to modify CONNECT for Quality, a provider-facing team building and communication intervention designed to facilitate implementation of a new clinical program. Methods This process of intervention adaptation involved the use of the Planned Adaptation Framework and the Framework for Reporting Adaptations and Modifications, for systematically identifying key drivers, core and non-core components of interventions for documenting planned and unplanned changes to intervention design. Results The CONNECT intervention’s original context and setting is first described and then compared with its new application. This lays the groundwork for the intentional modifications to intervention design, which are developed before intervention delivery to participating providers. The unpredictable nature of implementation in real-world practice required unplanned adaptations, which were also considered and documented. Attendance and participation rates were examined and qualitative assessment of reported participant experience supported the feasibility and acceptability of adaptations of the original CONNECT intervention in a new clinical context. Conclusion This approach may serve as a useful guide for intervention implementation efforts applied in diverse clinical contexts and subsequent evaluations of intervention effectiveness. Trial registration The study was registered at ClinicalTrials.gov (NCT03300336) on September 28, 2017.

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The what, why and when of adapting interventions for new contexts: A qualitative study of researchers, funders, journal editors and practitioners’ understandings

Cited by 10 publications

References 59 publications

Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management

Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management

Adapting interventions to new contexts—the ADAPT guidance

Adapting to CONNECT: modifying a nursing home-based team-building intervention to improve hospital care team interactions, functioning, and implementation readiness

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