Table 8.

Training and evaluation adaptations

Adaptations	Original protocol	What was adapted	When adaptation occurred	Planned or reactive	At what level of delivery	Intent of adaptation
Wellness partners were trained based on previous work by Puspitasari et al. [33].	Original protocol did not specify wellness partner training	Adding elements	Pre-implementation	Planned: Part of the plan to modify to maximize fit and implementation success	Individual patient/practitioner level	To increase implementation/ability of staff to deliver intervention successfully
Wellness partners were retrained throughout the intervention implementation.	Original protocol did not utilize retraining sessions for wellness partners	Adding elements	Post-implementation	Planned: Part of the plan to modify to maximize fit and implementation success	Individual patient/practitioner level	To increase implementation/ability of staff to deliver intervention successfully
Pharmacy students were trained on how to support wellness partners during MO.	Original protocol did not train pharmacy students to aid in MO	Adding elements	Post-implementation	Reactive: Unplanned often in response to an obstacle, challenge, deviation from the plan	Individual patient/practitioner level	To increase implementation/ability of staff to deliver intervention successfully
Data collection was simplified, including revision of suicide risk, alcohol consumption, opioid, falls, and medication questions.	The research coordinator used the Behavioral Activation for Depression Scale – Short Form (BADS-SF) and the Veterans RAND – 12 (VR-12) to measure target engagement and quality of life.	Loosening structure	Post-implementation	Reactive: Unplanned often in response to an obstacle, challenge, deviation from the plan	Individual patient/practitioner level	To increase implementation/ability of staff to deliver intervention successfully
Data on hospital readmissions and follow-ups were collected.	Originally, data on hospital readmissions and follow-ups were not collected.	Adding elements	Post-implementation	Planned: Part of the plan to modify to maximize fit and implementation success	Individual patient/practitioner level	To increase reach, participation, access
Only 1-month and 3-month follow-ups were collected.	Originally, 1-month, 2-month, and 3-month follow-ups were collected.	Removing/skipping elements	Post-implementation	Reactive: Unplanned often in response to an obstacle, challenge, deviation from the plan	Target intervention group level	To increase reach, participation, access
REDCap session documentation forms were revised to include a general emotional health question.	Originally, REDCap had a question that assumed that the patient had depression and anxiety and forced patients to provide ratings.	Adding elements	Post-implementation	Reactive: Unplanned often in response to an obstacle, challenge, deviation from the plan	Individual patient/practitioner level	To increase implementation/ability of staff to deliver intervention successfully
Future RCTs will use chart-based delirium detection tool (CHART-DEL) [55] to obtain delirium assessments.	The original protocol used in-person confusion assessment method (CAM) [56].	Substituting components	Post-implementation	Planned: Part of the plan to modify to maximize fit and implementation success	Individual patient/practitioner level	To increase implementation/ability of staff to deliver intervention successfully