Table 1.

Adaptation outcomes using the framework for reporting adaptations and modifications to evidence-based implementation strategies (FRAME-IS)

Goal of the modification	Who participated in the decision to modify?	What is modified? (nature of content modification)	Fidelity to core elements
To facilitate weekly monitoring of clinical measurements in the context of prohibited research-related face-to-face interactions	Principal investigator CHA Participants	Content: unchanged; clinical measurements were continued on a weekly basis. Context: changed. Original: clinical measurements conducted by the CHA at the FBO Adaptation: clinical measures performed by the participants at home.	Fidelity: consistent; during the face-to-face format, the visit rate was 95%. This is comparable with the previous cohort where the visit rate was 94.8%. During the adapted online format, the visit rate was 97.8%.
To facilitate the documentation of clinical measurements to allow the principal investigator to monitor the status	Principal investigator CHA Participants	Content: unchanged; clinical data was reviewed on a weekly basis. Context: changed. Original: data was entered by CHAs into the online REDCap database. Adaptation: data was posted by participants in the WhatsApp mobile application and then uploaded by the CHA to the REDCap database.	Fidelity: consistent; the ability of the PI to monitor hinged on the data entered (see row above).
To provide participants with an alternative to the liquid low-calorie diet formulation	Principal investigator CHA Participants Dietician	Content: unchanged; the daily calorie allowance remained at 840kcal/day. Context: changed Original: diet comprised mainly of a liquid formulation. Adaptation: diet comprised a mixture of solid and liquid formulation.	Fidelity: partially consistent. One participant experienced some difficulty both sourcing and preparing the solid low-calorie diet.