Table 2.
Unique adaptations identified across time points and various constructs of the modified adaptation framework
| Adaptation constructs | Pre-I | Early-I | Mid-I | Late-I | Sustainment | Total |
|---|---|---|---|---|---|---|
| Elements | ||||||
| Format | 0 | 0 | 2 | 1 | 0 | 3 |
| Personnel involved | 1 | 0 | 7 | 1 | 0 | 9 |
| Target population | 0 | 4 | 16 | 2 | 0 | 22 |
| Intervention presentation | 0 | 2 | 4 | 0 | 0 | 6 |
| Others | 0 | 0 | 1 | 0 | 0 | 1 |
| What was changed | ||||||
| Tailoring to individuals | 0 | 0 | 3 | 2 | 0 | 5 |
| Adding a component | 0 | 0 | 0 | 0 | 0 | 0 |
| Removing a component | 0 | 0 | 0 | 0 | 0 | 0 |
| Condensing a component | 0 | 0 | 0 | 0 | 0 | 0 |
| Extending a component | 0 | 0 | 1 | 0 | 0 | 1 |
| Substituting for a component | 0 | 0 | 1 | 0 | 0 | 1 |
| Changing the order of components | 0 | 0 | 0 | 0 | 0 | 0 |
| Integrating with other programs | 0 | 3 | 1 | 0 | 0 | 4 |
| Repeating a component | 0 | 0 | 0 | 0 | 0 | 0 |
| Loosening the structure or protocol | 0 | 0 | 0 | 0 | 0 | 0 |
| Otherwise changing the intervention | 1 | 3 | 24 | 2 | 0 | 30 |
| Who was responsible for this change | ||||||
| Entire or most of the team | 0 | 3 | 9 | 0 | 0 | 12 |
| Provider (TN/SC) | 1 | 3 | 16 | 0 | 0 | 20 |
| Administrator | 0 | 0 | 3 | 1 | 0 | 4 |
| Researcher | 0 | 0 | 0 | 3 | 0 | 3 |
| Developer | 0 | 0 | 0 | 0 | 0 | 0 |
| Stakeholder | 0 | 0 | 1 | 0 | 0 | 1 |
| Coalition | 0 | 0 | 1 | 0 | 0 | 1 |
| How or on what basis were these changes made | ||||||
| Based on our vision or values | 0 | 0 | 1 | 2 | 0 | 3 |
| Based on a framework | 0 | 0 | 0 | 0 | 0 | 0 |
| Based on our knowledge or experience | 0 | 1 | 7 | 0 | 0 | 8 |
| Based on QI data, summary information, or results | 0 | 0 | 0 | 0 | 0 | 0 |
| Based on pragmatic/practical considerations | 1 | 3 | 18 | 1 | 0 | 23 |
| Based on financial incentives/payments | 0 | 0 | 0 | 0 | 0 | 0 |
| Based on feedback or suggestions | 0 | 1 | 3 | 1 | 0 | 5 |
| Others | 0 | 1 | 1 | 0 | 0 | 2 |
| Why was the change made | ||||||
| To increase the number or type of patients contacted (Reach) | 0 | 1 | 10 | 3 | 0 | 14 |
| To enhance the impact or success of the intervention for all or important subgroups (Effectiveness) | 0 | 2 | 6 | 0 | 0 | 8 |
| To make it possible to involve more teams, team members, or staff (Adoption) | 0 | 0 | 0 | 0 | 0 | 0 |
| To make the intervention delivered more consistently; to better fit our practice, patient flow, or EHR; for practical reasons (Implementation) | 0 | 2 | 7 | 1 | 0 | 10 |
| To save money or other resources (Implementation) | 0 | 0 | 0 | 0 | 0 | 0 |
| To institutionalize or sustain the intervention (Maintenance) | 0 | 0 | 0 | 0 | 0 | 0 |
| To respond to external pressures or policy | 0 | 0 | 1 | 0 | 0 | 1 |
| Others | 1 | 1 | 6 | 0 | 0 | 8 |
| Short-term impact of the change | ||||||
| Positive | 0 | 5 | 18 | 3 | 0 | 26 |
| Negative | 0 | 0 | 3 | 0 | 0 | 3 |
| Unknown | 1 | 1 | 9 | 1 | 0 | 12 |
Pre-I pre-implementation, Early-I early implementation, Imp implementation, Late-I late implementation, Sustainment