Table 2.

Original Intervention Description, Adaptation Goals, Frameworks, and Details of Adaptations in Included Studies (n = 11)

Author, year	Original intervention description	Adaptation goal(s)	Adaptation framework/methods	Description of adaptation(s) made to original EBI	Potential impact(s) on original intervention
Abraham, 2018	CALM facilitates the delivery of CBT by mental health providers in outpatient settings, using a cognitive behavioral framework including psychoeducation, cognitive restructuring, goal setting, exposure, & response prevention. The patient & provider both look at the computer screen together & proceed through the modules at an individualized pace	Adapt original CALM program for use in rural outpatient VA settings	ADDIE model	(1) General images were placed with images of veterans. (2) A new template with the VA logo was developed. (3) Videos of veterans describing their treatment and illness experiences were embedded. (4) Case studies were modified to better reflect experiences common to rural veterans. (5) Veterans were given the option of orally recounting (as opposed to only writing) their trauma experiences	These modifications likely had no impact on the integrity of the original program, better reflect the demographic characteristics and of rural veterans, and offer patient-centered health care consisting of treatment options that can be tailored to each individual veteran’s needs
Arney, 2018	Empowering Patients in Chronic Care (EPIC) is a group-based intervention to aid patients in setting personalized goals for diabetes control, delivered by research staff & designed to occur over four sessions among a group of 5–7 participants	Assess the effectiveness of EPIC after implementation into routine care in five primary care sites	PARIHS	(1) The amount of information presented in each session was decreased. (2) The number of sessions was increased. (3) Patient reading materials were simplified	Training was incentivized with Continuing Education Units to encourage fidelity to the intervention. The training protocol was tailored to address common concerns and improve staff engagement. Strategic multilevel partnerships were developed to ensure the mobilization of necessary resources and broad support for the intervention
Blonigen, 2018	Moral Reconation Therapy (MRT) is a cognitive behavioral intervention that aims to reduce criminogenic thinking & criminal recidivism	Assess use of MRT in a non-correctional setting and within a mental health treatment program	RE-AIM	N/A (protocol paper, potential adaptations to be studied)
Blonigen, 2020	Step Away is a mobile-based intervention program for individuals who want to reduce or abstain from drinking but are unable or unwilling to receive in-person care	Repurpose the Step Away intervention for general populations to create a version that maximizes engagement and effectiveness with veterans	M-PACE model	(1) App text shortened to break up long paragraphs and enumerate key information. (2) App icon replaced with an image of an American flag. (3) Videos of veterans describing their recovery from drinking problems were embedded. (4) The app name was rebranded	These changes are unlikely to have an adverse impact on the effectiveness of the Step Away program and may have the benefit of increasing the extent to which veterans identify with the app
Day, 2021	PIVOT is a flexible video telehealth-to-home (VTH) implementation strategy that is adaptive to site-specific contexts & different digital innovations	Use PIVOT to improve VTH adoption in rural settings	Formative evaluation	(1) Rurality as a cultural factor was addressed to account for components of rurality (i.e., rural identity, traditions, and perceptions of help seeking or care). (2) Considerations were made for sites with a smaller or less specialized workforce. (3) Considerations were made for providers who may be accustomed to operating independently, have minimal time or motivation to enact practice changes, and have important perspectives on how to address unique barriers to implementation faced by rural sites. (4) Internal facilitators were identified to act as points of contact to improve understanding of the specific site context, demonstrate commitment to the site’s priorities, and increase engagement by fostering trust and credibility	The inclusion of a comprehensive assessment of the rural site, including infrastructure and resources, greatly improves understanding of a site’s specific needs and enables a tailored approach that targets relevant barriers
Dyer, 2020	The Diabetes Prevention Program (DPP) is an intensive lifestyle intervention to lower the risk of incident diabetes	Assess the impact of gender-tailoring and modality choice (online vs. in-person) on women veterans’ perceptions of and engagement in tailored DPP	Formative evaluation	(1) Included gender-specific groups. (2) Allowed participants to choose from online or in-person modalities	Tailored DPP effectively addressed known barriers to intervention engagement in women veterans with prediabetes, such as potential discomfort in mixed-gender groups, transportation difficulties, rural residence, schedule conflicts, and limited computer literacy or access
Hoerster, 2020	MOVE! Is a behavioral weight management program that uses techniques like goal setting, self-monitoring, & motivational interviewing through in-person group sessions	Develop, pilot, and refine a tailored behavioral weight management program for veterans with PTSD	VA Peer Support Implementation Toolkit	(1) Adapted standard MOVE! materials to allow for PTSD-specific content. (2) In-person sessions included walking outdoors adjacent to the VA facility, to provide exercise, to address hypervigilance-based activity barriers, and to encourage participants to walk in their own communities outside of MOVE! + UP sessions	Refining MOVE! UP appears to have yielded a more valuable, acceptable, and feasible program and study procedures
King, 2014	A yoga intervention with positive findings for women at middle age	Adapt for an older and predominantly male veteran population	RE-AIM	(1) Modifications were made to physical yoga poses as most participants required modification of at least one or more poses. (2) Modifications were made to the instruction, adapting teaching in response to participants appearing “confused, tearful, distracted, or fidgety”. (3) Material was covered more slowly and at a more basic level	There was a broad range in participants’ functioning and required adaptations. Resulting in the development of a unique protocol for each veteran participant, rather than for all veteran participants in the class. This raises concerns about how to most effectively conduct group research on this population going forward
Leonard, 2019	Transitions Nurse Program (TNP) is a multi-component, nurse-led intensive care coordination intervention designed to improve care transitions	Adapt for rural veterans who are hospitalized at VA hospitals & subsequently discharged to their rural residence & care setting	PRISM	(1) Created clear role descriptions and brainstormed ways to utilize existing infrastructure. (2) Modified program enrollment criteria at sites concerned with an overwhelming number of eligible patients. (3) Encouraged Transition Nurses to provide informational sessions at PACT sites to engage stakeholders and initiate relationships	Making these adaptations early in the implementation process helped to roll out the EBI more quickly at each site
Rubenstein, 2010	Translating Initiatives in Depression into Effective Solutions (TIDES) implements research-based depression collaborative care in primary care practices	Adapt for VA primary care practices	EBQI	(1) Presented regional leaders, local leaders, and workgroups with scientific evidence and enabled them to pick the features they considered best suited to their contexts	TIDES developed an evidence-based depression collaborative care prototype with excellent overall patient outcomes
Yano, 2008	US Public Health Service smoking cessation guidelines	Implement smoking cessation interventions in the context of local VA practice needs and to have the intervention delivered by healthcare managers rather than researchers	EBQI	(1) Researchers facilitated discussions with site leadership to promote ongoing local adaptations of the interventions	Facilities were encouraged to try new methods of encouraging smoking cessation among patients; however, this did not translate into improved quit rates among the veteran samples studied

ADDIE Analysis, Design, Development, Implementation, Evaluation model, CBT cognitive behavioral therapy, EBQI evidence-based quality initiative, M-PACE Method for Program Adaptation through Community Engagement, PARIHS Promoting Action on research in Health Services, PHQ Patient Health Questionnaire, PRISM Practical Robust Implementation & Sustainability Model, RE-AIM Reach, Effectiveness, Adoption, Implementation, & Maintenance