Table 5.
Adaptations identified across implementation timepoints
| Adaptation constructs | Adaptation elements | Pre-implementation | Post-implementation | Total |
|---|---|---|---|---|
| WHAT is adapted? | Content: intervention elements | 9 | 13 | 22 |
| Contextual: research, population, format, delivery mode, setting, and personnel | 6 | 15 | 21 | |
| Training and evaluation: how staff are trained and how intervention is evaluated (e.g., outcomes) | 1 | 7 | 8 | |
| What is the NATURE of the intervention adaptation? | Tailoring/rewording/refining | 8 | 10 | 18 |
| Integrating another treatment into the intervention | 0 | 1 | 1 | |
| Removing/skipping elements | 1 | 3 | 4 | |
| Lengthening/extending (pacing/timing) | 0 | 1 | 1 | |
| Adjusting the order of intervention components | 2 | 2 | 4 | |
| Adding elements | 6 | 13 | 19 | |
| Loosening structure | 0 | 2 | 2 | |
| Substituting components | 0 | 2 | 2 | |
| Was the adaptation planned or reactive? | Planned | 16 | 12 | 28 |
| Reactive | 0 | 23 | 23 | |
| At what LEVEL of DELIVERY is the content level adaptation? | Individual patient or practitioner level | 10 | 26 | 36 |
| Target intervention group level | 8 | 7 | 15 | |
| HOW or on what basis was this change made? | Based on vision or values | 3 | 7 | 10 |
| Based on a framework | 4 | 1 | 5 | |
| Based on knowledge and experience working with patients | 0 | 9 | 9 | |
| Based on practical considerations | 8 | 18 | 26 | |
| Based on financial incentives/payments | 0 | 0 | 0 | |
| Based on feedback or suggestions | 0 | 1 | 1 | |
| WHY? What is the purpose of the adaptation? | Increase reach, participation, access | 3 | 12 | 15 |
| Increase effectiveness | 6 | 4 | 10 | |
| Make intervention more aligned with organization goals | 1 | 4 | 5 | |
| Increase implementation/ability of staff to deliver intervention successfully | 6 | 15 | 21 |