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Brewer SK, Corbin CM, Baumann AA, Stirman SW, Jones JM, Pullmann MD, Lyon AR. Development of a method for Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI): a modified Delphi study. Implement Sci Commun 2024; 5:64. [PMID: 38886834 PMCID: PMC11181660 DOI: 10.1186/s43058-024-00592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/03/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Intervention adaptation is often necessary to improve the fit between evidence-based practices/programs and implementation contexts. Existing frameworks describe intervention adaptation processes but do not provide detailed steps for prospectively designing adaptations, are designed for researchers, and require substantial time and resources to complete. A pragmatic approach to guide implementers through developing and assessing adaptations in local contexts is needed. The goal of this project was to develop Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI), a method for intervention adaptation that leverages human centered design methods and is tailored to the needs of intervention implementers working in applied settings with limited time and resources. METHOD MODIFI was iteratively developed via a mixed-methods modified Delphi process. Feedback was collected from 43 implementation research and practice experts. Two rounds of data collection gathered quantitative ratings of acceptability and inclusion (Round 1) and feasibility (Round 2), as well as qualitative feedback regarding MODIFI revisions analyzed using conventional content analysis. RESULTS In Round 1, most participants rated all proposed components as essential but identified important avenues for revision which were incorporated into MODIFI prior to Round 2. Round 2 emphasized feasibility, where ratings were generally high and fewer substantive revisions were recommended. Round 2 changes largely surrounded operationalization of terms/processes and sequencing of content. Results include a detailed presentation of the final version of the three-step MODIFI method (Step 1: Learn about the users, local context, and intervention; Step 2: Adapt the intervention; Step 3: Evaluate the adaptation) along with a case example of its application. DISCUSSION MODIFI is a pragmatic method that was developed to extend the contributions of other research-based adaptation theories, models, and frameworks while integrating methods that are tailored to the needs of intervention implementers. Guiding teams to tailor evidence-based interventions to their local context may extend for whom, where, and under what conditions an intervention can be effective.
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Affiliation(s)
- Stephanie K Brewer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 6200 NE 74Th St, Suite 100, Seattle, WA, 98115, USA.
| | - Catherine M Corbin
- School of Special Education, School Psychology, and Early Childhood Studies, College of Education, University of Florida, Norman Hall, Room 1801, Gainesville, FL, 32611, USA
| | - Ana A Baumann
- Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave, Attn: Ana Bauman, MSC:8100-0094-02, St. Louis, MO, 63110, USA
| | - Shannon Wiltsey Stirman
- Department of Psychiatry and Behavioral Sciences, Stanford University, 795 Willow Rd. (NC-PTSD), Menlo Park, CA, 94025, USA
| | - Janine M Jones
- College of Education, University of Washington, Miller Hall 322 S, Campus, Box 353600, Seattle, WA, 98195, USA
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 6200 NE 74Th St, Suite 100, Seattle, WA, 98115, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 6200 NE 74Th St, Suite 100, Seattle, WA, 98115, USA
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Herbst AN, McCullough MB, Wiener RS, Barker AM, Maguire EM, Fix GM. Proactively tailoring implementation: the case of shared decision-making for lung cancer screening across the VA New England Healthcare Network. BMC Health Serv Res 2023; 23:1282. [PMID: 37993840 PMCID: PMC10664378 DOI: 10.1186/s12913-023-10245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Shared Decision-Making to discuss how the benefits and harms of lung cancer screening align with patient values is required by the US Centers for Medicare and Medicaid and recommended by multiple organizations. Barriers at organizational, clinician, clinical encounter, and patient levels prevent SDM from meeting quality standards in routine practice. We developed an implementation plan, using the socio-ecological model, for Shared Decision-Making for lung cancer screening for the Department of Veterans Affairs (VA) New England Healthcare System. Because understanding the local context is critical to implementation success, we sought to proactively tailor our original implementation plan, to address barriers to achieving guideline-concordant lung cancer screening. METHODS We conducted a formative evaluation using an ethnographic approach to proactively identify barriers to Shared Decision-Making and tailor our implementation plan. Data consisted of qualitative interviews with leadership and clinicians from seven VA New England medical centers, regional meeting notes, and Shared Decision-Making scripts and documents used by providers. Tailoring was guided by the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). RESULTS We tailored the original implementation plan to address barriers we identified at the organizational, clinician, clinical encounter, and patient levels. Overall, we removed two implementation strategies, added five strategies, and modified the content of two strategies. For example, at the clinician level, we learned that past personal and clinical experiences predisposed clinicians to focus on the benefits of lung cancer screening. To address this barrier, we modified the content of our original implementation strategy Make Training Dynamic to prompt providers to self-reflect about their screening beliefs and values, encouraging them to discuss both the benefits and potential harms of lung cancer screening. CONCLUSIONS Formative evaluations can be used to proactively tailor implementation strategies to fit local contexts. We tailored our implementation plan to address unique barriers we identified, with the goal of improving implementation success. The FRAME-IS aided our team in thoughtfully addressing and modifying our original implementation plan. Others seeking to maximize the effectiveness of complex interventions may consider using a similar approach.
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Affiliation(s)
- Abigail N Herbst
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Megan B McCullough
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
- Department of Public Health, Zuckerberg School of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, US, USA
- The Pulmonary Center, Boston University Chobanian &, Avedisian School of Medicine, Boston, MA, USA
| | - Anna M Barker
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Elizabeth M Maguire
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Gemmae M Fix
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA.
- General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Brewer SK, Corbin CM, Baumann AA, Stirman SW, Jones JM, Pullmann MD, Lyon AR. Development of a method for Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI): A modified Delphi study. RESEARCH SQUARE 2023:rs.3.rs-3467152. [PMID: 37961432 PMCID: PMC10635387 DOI: 10.21203/rs.3.rs-3467152/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Intervention adaptation is often necessary to improve the fit between evidence-based practices/programs and implementation contexts. Existing frameworks describe intervention adaptation processes but do not provide detailed steps for prospectively designing adaptations, are designed for researchers, and require substantial time and resources to complete. A pragmatic approach to guide implementers through developing and assessing adaptations in local contexts is needed. The goal of this project was to develop Making Optimal Decisions for Intervention Flexibility during Implementation (MODIFI), a method for intervention adaptation that leverages human centered design methods and is tailored to the needs of intervention implementers working in applied settings with limited time and resources. Method MODIFI was iteratively developed via a mixed-methods modified Delphi process. Feedback was collected from 43 implementation research and practice experts. Two rounds of data collection gathered quantitative ratings of acceptability (Round 1) and feasibility (Round 2), as well as qualitative feedback regarding MODIFI revisions analyzed using conventional content analysis. Results In Round 1, most participants rated all proposed components as essential but identified important avenues for revision which were incorporated into MODIFI prior to Round 2. Round 2 emphasized feasibility, where ratings were generally high and fewer substantive revisions were recommended. Round 2 changes largely surrounded operationalization of terms/processes and sequencing of content. Results include a detailed presentation of the final version of the three-step MODIFI method (Step 1: Learn about the users, local context, and intervention; Step 2: Adapt the intervention; Step 3: Evaluate the adaptation) along with a case example of its application. Discussion MODIFI is a pragmatic method that was developed to extend the contributions of other research-based adaptation theories, models, and frameworks while integrating methods that are tailored to the needs of intervention implementers. Guiding teams to tailor evidence-based interventions to their local context may extend for whom, where, and under what conditions an intervention can be effective.
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Affiliation(s)
| | | | - Ana A Baumann
- Washington University School of Medicine in Saint Louis: Washington University in St Louis School of Medicine
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Motamedi M, Lau AS, Byeon YV, Yu SH, Brookman-Frazee L. Supporting Emotionally Exhausted Community Mental Health Therapists in Appropriately Adapting EBPs for Children and Adolescents. J Behav Health Serv Res 2023; 50:468-485. [PMID: 37430134 DOI: 10.1007/s11414-023-09844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/12/2023]
Abstract
Evidence-based practices (EBPs) are often adapted during community implementation to improve EBP fit for clients and the service context. Augmenting EBPs with additional dosing and content may improve fit. However, reducing EBP content can reduce EBP effectiveness. Using multilevel regression models, this study examined whether supportive program climate and program-furnished EBP-specific implementation strategies (e.g., materials, ongoing training, in-house experts) are associated with augmenting and reducing adaptations, and whether therapist emotional exhaustion moderated these associations. Data were collected from surveys completed by 439 therapists from 102 programs 9 years after a system-driven EBP implementation initiative. Supportive program climate was associated with more augmenting adaptations. Emotional exhaustion was a significant moderator. When organizations used more EBP-specific implementation strategies, more emotionally exhausted therapists reduced EBPs less and less emotionally exhausted therapists augmented EBPs more. Findings provide guidance on how organizations can support appropriate EBP adaptations in spite of therapist emotional exhaustion.
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Affiliation(s)
- Mojdeh Motamedi
- University of California San Diego, La Jolla, USA.
- Child and Adolescent Services Research Center, San Diego, USA.
| | - Anna S Lau
- University of California Los Angeles, Los Angeles, USA
| | | | | | - Lauren Brookman-Frazee
- University of California San Diego, La Jolla, USA
- Child and Adolescent Services Research Center, San Diego, USA
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Kaiser BN, Kaufman J, Wall JT, Healy EAF, Ayuku D, Aarons GA, Puffer ES. Assessing ad-hoc adaptations' alignment with therapeutic goals: a qualitative study of lay counselor-delivered family therapy in Eldoret, Kenya. Implement Sci Commun 2023; 4:105. [PMID: 37644561 PMCID: PMC10464241 DOI: 10.1186/s43058-023-00477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/26/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND A key question in implementation science is how to balance adaptation and fidelity in translating interventions to new settings. There is growing consensus regarding the importance of planned adaptations to deliver interventions in contextually sensitive ways. However, less research has examined ad-hoc adaptations, or those that occur spontaneously in the course of intervention delivery. A key question is whether ad-hoc adaptations ultimately contribute to or detract from intervention goals. This study aimed to (a) identify ad-hoc adaptations made during delivery of a family therapy intervention and (b) assess whether they promoted or interrupted intervention goals. METHODS Tuko Pamoja (Swahili: "We are Together") is an evidence-informed family therapy intervention aiming to improve family dynamics and mental health in Kenya. Tuko Pamoja employs a task-shifting model, delivered by lay counselors who are afforded a degree of flexibility in presenting content and in practices they use in sessions. We used transcripts of therapy sessions with 14 families to examine ad-hoc adaptations used by counselors. We first identified and characterized ad-hoc adaptations through a team-based code development, coding, and code description process. Then, we evaluated to what extent ad-hoc adaptations promoted the principles and strategies of the intervention ("TP-promoting"), disrupted them ("TP-interrupting"), or neither ("TP-neutral"). To do this, we first established inter-coder agreement on application of these categories with verification by the intervention developer. Then, coders categorized ad-hoc adaptation text segments as TP-promoting, TP-interrupting, or TP-neutral. RESULTS Ad-hoc adaptations were frequent and included (in decreasing order): incorporation of religious content, exemplars/role models, community dynamics and resources, self-disclosure, and metaphors/proverbs. Ad-hoc adaptations were largely TP-promoting (49%) or neutral (39%), but practices were TP-interrupting 12% of the time. TP-interrupting practices most often occurred within religious content and exemplars/role models, which were also the most common practices overall. CONCLUSION Extra attention is needed during planned adaptation, training, and supervision to promote intervention-aligned use of common ad-hoc adaptation practices. Discussing them in trainings can provide guidance for lay providers on how best to incorporate ad-hoc adaptations during delivery. Future research should evaluate whether well-aligned ad-hoc adaptations improve therapeutic outcomes. TRIAL REGISTRATION Pilot trial registered at clinicaltrials.gov (C0058).
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Affiliation(s)
- Bonnie N Kaiser
- Department of Anthropology; Global Health Program, University of California San Diego, La Jolla, CA, USA.
- Duke Global Health Institute, Durham, NC, USA.
| | | | | | - Elsa A Friis Healy
- Duke Global Health Institute, Durham, NC, USA
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - David Ayuku
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- ACTRI Dissemination and Implementation Science Center, University of Cailfornia San Diego, La Jolla, CA, USA
| | - Eve S Puffer
- Duke Global Health Institute, Durham, NC, USA
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
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Bender BG, Cvietusa PJ, Goodrich GK, King DK, Shoup JA. Adapting adaptive design methods to accelerate adoption of a digital asthma management intervention. Transl Behav Med 2023; 13:149-155. [PMID: 36689336 PMCID: PMC10068903 DOI: 10.1093/tbm/ibac093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Investigators conducting translational research in real-world settings may experience changes that create challenges to the successful completion of the trial as well as post-trial adoption and implementation. Adaptive designs support translational research by systematically adapting content and methods to meet the needs of target populations, settings and contexts. This manuscript describes an adaptive implementation research model that provides strategies for changing content, delivery processes, and research methods to correct course when anticipated and unanticipated circumstances occur during a pragmatic trial. The Breathewell Program included two large pragmatic trials of the effectiveness of a digital communication technology intervention to improve symptom management and medication adherence in asthma care. The first trial targeted parents of children with asthma; the second targeted adults with asthma. Adaptations were made iteratively to adjust to dynamic conditions within the healthcare setting, informed by prospectively collected stakeholder input, and were categorized retrospectively by the authors as proactive or reactive. Study outcomes demonstrated improved treatment adherence and clinical efficiency. Kaiser Permanente Colorado, the setting for both studies, adopted the speech recognition intervention into routine care, however, both interventions required numerous adaptations, including changes to target population, intervention content, and internal workflows. Proactive and reactive adaptations assured that both trials were successfully completed. Adaptive research designs will continue to provide an important pathway to move healthcare delivery research into practice while conducting ongoing effectiveness evaluation.
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Affiliation(s)
- Bruce G Bender
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Peter J Cvietusa
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
- Department of Asthma, Allergy and Immunology, Permanente Medical Group, Denver, CO, USA
| | - Glenn K Goodrich
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | - Diane K King
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, AK, USA
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
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Hasson H, Hedberg Rundgren E, Strehlenert H, Gärdegård A, Uvhagen H, Klinga C, Hedberg Rundgren Å, von Thiele Schwarz U. The adaptation and fidelity tool to support social service practitioners in balancing fidelity and adaptations: Longitudinal, mixed-method evaluation study. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231189198. [PMID: 37790175 PMCID: PMC10392202 DOI: 10.1177/26334895231189198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background Evidence-based interventions (EBIs) seldom fit seamlessly into a setting and are often adapted. The literature identifies practitioners' management of fidelity and adaptations as problematic but offers little guidance. This study aimed to investigate practitioners' perceptions of the feasibility and usability of an intervention aimed to support them in fidelity and adaptation management when working with EBIs. Methods The intervention, the adaptation and fidelity tool (A-FiT), was developed based on the literature, along with input from social service practitioners and social services' Research and Development units' personnel. The intervention consisted of two workshops where the participants were guided through a five-step process to manage fidelity and adaptations. It was tested in a longitudinal mixed-method intervention study with 103 practitioners from 19 social service units in Stockholm, Sweden. A multimethod data collection was employed, which included interviews at follow-up, questionnaires at baseline and follow-up (readiness for change and self-rated knowledge), workshop evaluation questionnaires (usability and feasibility) after each workshop, and documentation (participants' notes on worksheets). To analyze the data, qualitative content analysis, Kruskal-Wallis tests, and Wilcoxon rank-sum tests were performed. Results Overall, the practitioners had a positive perception of the intervention and perceived it as relevant for fidelity and adaptation management (mean ratings over 7.0 on usability and feasibility). The workshops also provided new knowledge and skills to manage fidelity and adaptations. Furthermore, the intervention provided insights into the practitioners' understanding about adaptation and fidelity through a more reflective approach. Conclusion Practical tools are needed to guide professionals not only to adhere to intervention core elements but also to help them to manage fidelity and adaptation. The proposed A-FiT intervention for practitioners' management of both fidelity and adaptation is a novel contribution to the implementation literature. Potentially, the next step is an evaluation of the intervention's impact in an experimental design.
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Affiliation(s)
- Henna Hasson
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden
| | - Emma Hedberg Rundgren
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Helena Strehlenert
- SOLIID Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Stockholm Gerontology Research Centre, Stockholm, Sweden
| | - Anna Gärdegård
- Stockholm Research and Development, Unit for Social Services (FOU Nordväst), Stockholm, Sweden
| | - Håkan Uvhagen
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Research and Development Unit for Elderly Persons (FOU nu), Stockholm Health Care Services, Stockholm, Sweden
- Academic Primary Healthcare Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Charlotte Klinga
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Research and Development Unit for Elderly Persons (FOU nu), Stockholm Health Care Services, Stockholm, Sweden
| | - Åsa Hedberg Rundgren
- Stockholm Gerontology Research Centre, Stockholm, Sweden
- Ageing Research Center, Karolinska Institutet, Sweden
| | - Ulrica von Thiele Schwarz
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Gordon EJ, Uriarte JJ, Anderson N, Romo E, Caicedo JC, Shumate M. Implementation and modification of an organizational-level intervention: a prospective analysis. Implement Sci Commun 2022; 3:59. [PMID: 35659156 PMCID: PMC9164326 DOI: 10.1186/s43058-022-00296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/05/2022] [Indexed: 11/12/2022] Open
Abstract
Background Modifications to interventions can jeopardize intervention outcomes. Pre-existing perceived barriers and facilitators to the intervention arising in the implementation preparation phase may help explain why modifications to the intervention may occur during the implementation phase. This two-site comparative case study describes modifications made to a complex organizational-level intervention and examines how known implementation science factors may have enabled such changes to occur. Methods Northwestern Medicine’sTM Hispanic Kidney Transplant Program (HKTP) is a culturally competent transplant center-based intervention designed to reduce disparities in living donor kidney transplantation among Hispanics. In-depth qualitative interviews and discussions were longitudinally conducted with transplant stakeholders (i.e., physicians, administrators, clinicians) at two kidney transplant programs with large Hispanic populations during implementation preparation and implementation phases. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis, and Stirman’s Framework for Reporting Adaptations and Modifications-Expanded (FRAME) guided modification classification. Results Across sites, 57 stakeholders participated in an interview, group discussion, and/or learning collaborative discussion. Site-B made more modifications than Site-A (n = 29 versus n = 18). Sites differed in the proportions of delaying/skipping (Site-A 50% versus Site-B 28%) and adding (Site-A 11% versus Site-B 28%) but had comparable substituting (Site-A 17% versus Site-B 17%) and tweaking (Site-A 17% versus Site-B 14%) modification types. Across sites, the transplant team consistently initiated the most modifications (Site-A 66%; Site-B 62%). While individuals initiated slightly more modifications at Site-B (21% versus Site-A 17%), institutions instigated proportionately slightly more modifications at Site-A (17% versus Site-B 10%). CFIR inner setting factors (i.e., structural characteristics, culture, available resources, implementation climate) that prominently emerged during the implementation preparation phase explained similarities and differences in sites’ modification numbers, types, and agents in the implementation phase. Conclusion Organizations implementing a culturally competent care intervention made modifications. CFIR inner setting factors emerging in the implementation preparation phase largely explained similarities and differences in study sites’ modifications. Identifying factors contributing to modifications may help institutions become better prepared to implement an intervention by addressing known factors in advance, which may foster greater fidelity leading to desired outcomes. Trial registration ClinicalTrials.govNCT03276390. We registered the study retrospectively on 9-7-17. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00296-0.
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Affiliation(s)
- Elisa J Gordon
- Department of Surgery - Division of Transplantation, Center for Health Services and Outcomes Research, Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair, 20th Floor, Chicago, IL, 60611, USA.
| | - Jefferson J Uriarte
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Naomi Anderson
- School of Education and Policy, Northwestern University, Evanston, IL, USA
| | - Elida Romo
- Department of Neurology - Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Juan Carlos Caicedo
- Department of Surgery - Division of Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michelle Shumate
- Department of Communication Studies, Northwestern University, Evanston, IL, USA
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Pettersson K, Liedgren P, Giannotta F, von Thiele Schwarz U. Eleven Reasons for Adaptation of Swedish Parenting Programs. FRONTIERS IN HEALTH SERVICES 2022; 2:923504. [PMID: 36925861 PMCID: PMC10012651 DOI: 10.3389/frhs.2022.923504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022]
Abstract
While questions about adaptation and fidelity are of great concern in many implementation projects, less attention has been paid to reasons for adaptations that remain when evidence-based interventions (EBIs) are used in clinical and community settings. This study aims to explore reasons for adaptations that can arise when using parenting programs in a community setting. Seventeen individual interviews with providers were conducted and analyzed thematically, resulting in 11 reasons for adaptations organized into four separate areas: characteristics of group leaders (supplementary skills and knowledge, preferred ways of working), characteristics of families (problem complexity, diverse or limited educational experience, non-parenting needs for support, colliding value systems), group incidents (criticism and challenges, excessive questions or discussions), and didactic challenges (lack of focus or engagement, limitations of the material, language differences). The study shows that factors triggering adaptation and fidelity decisions continuously reappear in the provision of parenting programs in community settings. Knowledge about reasons for adaptation can be used to inform decision-making during implementation planning, as well as the sustainment of implemented interventions.
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Affiliation(s)
| | - Pernilla Liedgren
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Fabrizia Giannotta
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden
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Pinheiro-Carozzo NP, Murta SG, Vinha LGDA, da Silva IM, Fontaine AMGV. Beyond effectiveness of the Strengthening Families Program (10-14): a scoping RE-AIM-based review. PSICOLOGIA-REFLEXAO E CRITICA 2021; 34:16. [PMID: 34131838 PMCID: PMC8206301 DOI: 10.1186/s41155-021-00182-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
A scoping review, based on the RE-AIM framework, was conducted to analyze evidence of reach, effectiveness, adoption, implementation, and maintenance of the Strengthening Families Program (10-14), a preventive family-based substance abuse program for adolescents. Sixty-five articles were included. The results disclosed that effectiveness, implementation, and maintenance at the individual-level were the most evaluated aspects, while reach, maintenance at the setting-level, and adoption were the least investigated aspects. Positive effects on drug abuse prevention and protective parenting factors were found in the U.S. studies. Likewise, Latin American studies have shown the improvement of parenting practices. However, European studies have produced mixed results, with predominantly null effects on substance abuse. The implementation quality was high. There is no available evidence of adoption and maintenance at the setting-level by the organizations that implemented it. New studies must examine the reach, adoption, and sustainability of the program to lay foundations for its future use as an instrument of public policies.
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Affiliation(s)
- Nádia P Pinheiro-Carozzo
- Departamento de Psicologia, Centro de Ciências Humanas, Universidade Federal do Maranhão, Cidade Universitária Dom Delgado, Avenida dos Portugueses, 1966, Bacanga, São Luis, MA, 65080-805, Brazil.
| | - Sheila G Murta
- Departamento de Psicologia Clínica, Instituto de Psicologia, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Luís Gustavo do A Vinha
- Departamento de Estatística, Instituto de Ciências Exatas, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Isabela M da Silva
- Departamento de Psicologia Clínica, Instituto de Psicologia, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Anne Marie G V Fontaine
- Faculdade de Psicologia e de Ciências da Educação, Universidade do Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
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Miller CJ, Barnett ML, Baumann AA, Gutner CA, Wiltsey-Stirman S. The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare. Implement Sci 2021; 16:36. [PMID: 33827716 PMCID: PMC8024675 DOI: 10.1186/s13012-021-01105-3] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/22/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Implementation strategies are necessary to ensure that evidence-based practices are successfully incorporated into routine clinical practice. Such strategies, however, are frequently modified to fit local populations, settings, and contexts. While such modifications can be crucial to implementation success, the literature on documenting and evaluating them is virtually nonexistent. In this paper, we therefore describe the development of a new framework for documenting modifications to implementation strategies. DISCUSSION We employed a multifaceted approach to developing the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS), incorporating multiple stakeholder perspectives. Development steps included presentations of initial versions of the FRAME-IS to solicit structured feedback from individual implementation scientists ("think-aloud" exercises) and larger, international groups of researchers. The FRAME-IS includes core and supplementary modules to document modifications to implementation strategies: what is modified, the nature of the modification (including the relationship to core elements or functions), the primary goal and rationale for the modification, timing of the modification, participants in the modification decision-making process, and how widespread the modification is. We provide an example of application of the FRAME-IS to an implementation project and provide guidance on how it may be used in future work. CONCLUSION Increasing attention is being given to modifications to evidence-based practices, but little work has investigated modifications to the implementation strategies used to implement such practices. To fill this gap, the FRAME-IS is meant to be a flexible, practical tool for documenting modifications to implementation strategies. Its use may help illuminate the pivotal processes and mechanisms by which implementation strategies exert their effects.
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Affiliation(s)
- Christopher J Miller
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Ana A Baumann
- Washington University at St. Louis, St. Louis, MO, USA
| | - Cassidy A Gutner
- ViiV Healthcare, Innovation & Implementation Science, Research Triangle, NC, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Shannon Wiltsey-Stirman
- National Center for PTSD Dissemination and Training Division, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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12
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Tiwari A, Smith S, Wekerle C, Kimber M, Jack SM, MacMillan H, Gonzalez A. Trauma services for youth victims of sexual abuse- does one size fit all? A qualitative study among service providers in Ontario, Canada. CHILD ABUSE & NEGLECT 2021; 112:104903. [PMID: 33412414 DOI: 10.1016/j.chiabu.2020.104903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite a range of interventions available to treat mental health symptoms experienced by youth with a history of child sexual abuse (CSA), limited empirical work has examined practitioner delivery of these interventions in real-world practice. OBJECTIVE This paper aimed to qualitatively explore the delivery of trauma-based interventions in community settings in Ontario, Canada. PARTICIPANTS AND SETTINGS Using qualitative description, a purposeful sample of service providers (N = 51; 92 % female) were recruited from nine community-based organizations located in Southern Ontario, Canada providing psychotherapeutic trauma-based interventions to youth with a history of child sexual abuse. METHODS Semi-structured one-on-one (n = 17), joint (n = 3) and focus group (n = 5) interviews elicited provider descriptions of their strategies and approaches for addressing trauma-related symptoms in this population. Data were interpreted using conventional content analyses. RESULTS Eclectic delivery of interventions and multifactorial decision-making processes were identified as core elements of treatment planning and intervention delivery among providers. Eclectic treatment was described to involve the consideration of four core elements (provider judgement; youth voice; youth characteristics; and clinical team discussion) of intervention and three key principles (meeting youth needs; providing client-centered care; addressing safety and stability). CONCLUSIONS Research capable of characterizing the efficacy of client-centered, eclectic approaches to treat symptoms experienced by youth with a history of CSA is needed.
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Affiliation(s)
- Ashwini Tiwari
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, Administration, B3, 100 West 5th, Hamilton, ON L8N 3K7 Canada.
| | - Savanah Smith
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8, Canada.
| | - Christine Wekerle
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8, Canada.
| | - Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, Administration, B3, 100 West 5th, Hamilton, ON L8N 3K7 Canada.
| | - Susan M Jack
- School of Nursing, McMaster University 1280 Main Street West, Hamilton, Ontario L8S4L8, Canada.
| | - Harriet MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, Administration, B3, 100 West 5th, Hamilton, ON L8N 3K7 Canada.
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, Administration, B3, 100 West 5th, Hamilton, ON L8N 3K7 Canada.
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13
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Cultural Adaptation Process of the Strengthening Families Program (10–14) Around the World: an Integrative Review. TRENDS IN PSYCHOLOGY 2020. [DOI: 10.1007/s43076-020-00053-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Thomas K, Bendtsen M, Linderoth C, Bendtsen P. Implementing Facilitated Access to a Text Messaging, Smoking Cessation Intervention Among Swedish Patients Having Elective Surgery: Qualitative Study of Patients' and Health Care Professionals' Perspectives. JMIR Mhealth Uhealth 2020; 8:e17563. [PMID: 32945772 PMCID: PMC7532460 DOI: 10.2196/17563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/23/2020] [Accepted: 06/16/2020] [Indexed: 01/11/2023] Open
Abstract
Background There is strong evidence that short-term smoking cessation before surgery can reduce postoperative morbidity. There are, however, several structural problems in health care systems concerning how to implement smoking cessation interventions in routine practice for preoperative patients. Objective This study aimed to analyze the implementation of a text messaging, smoking cessation intervention targeting patients having elective surgery. Implementation of facilitated access (ie, referral from practitioners) and the perceived usefulness among patients were investigated. Elective surgery is defined as scheduled, nonacute surgery. Methods A qualitative study was carried out at two medium-sized hospitals in the south of Sweden. The implementation of facilitated access was investigated during a 12-month period from April 2018 to April 2019. Facilitated access was conceptualized as specialists recommending the text messaging intervention to patients having elective surgery. Implementation was explored in terms of perceptions about the intervention and behaviors associated with implementation; that is, how patients used the intervention and how specialists behaved in facilitating usage among patients. Two focus groups with smoking cessation specialists and 10 individual interviews with patients were carried out. Qualitative content analysis was used to analyze the data. Results Two main categories were identified from the focus group data with smoking cessation specialists: implementation approach and perceptions about the intervention. The first category, implementation approach, referred to how specialists adapted their efforts to situational factors and to the needs and preferences of patients, and how building of trust with patients was prioritized. The second category, perceptions about the intervention, showed that specialists thought the content and structure of the text messaging intervention felt familiar and worked well as a complement to current practice. Two categories were identified from the patient interview data: incorporating new means of support from health care and determinants of use. The first category referred to how patients adopted and incorporated the intervention into their smoking cessation journey. Patients were receptive, shared the text messages with friends and family, humanized the text messages, and used the messages as a complement to other strategies to quit smoking. The second category, determinants of use, referred to aspects that influenced how and when patients used the intervention and included the following: timing of the intervention and text messages, motivation to change, and perceptions of the mobile phone medium. Conclusions Smoking cessation specialists adopted an active role in implementing the intervention by adapting their approach and fitting the intervention into existing routines. Patients showed strong motivation to change and openness to incorporate the intervention into their behavior change journey; however, the timing of the intervention and messages were important in optimizing the support. A text messaging, smoking cessation intervention can be a valuable and feasible way to reach smoking patients having elective surgery.
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Affiliation(s)
- Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Catharina Linderoth
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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15
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Roscoe JN, Shapiro VB, Whitaker K, Kim BKE. Classifying Changes to Preventive Interventions: Applying Adaptation Taxonomies. J Prim Prev 2020; 40:89-109. [PMID: 30635827 DOI: 10.1007/s10935-018-00531-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
High-quality implementation is important for preventive intervention effectiveness. Although this implies fidelity to a practice model, some adaptation may be inevitable or even advantageous in routine practice settings. In order to organize the study of adaptation and its effect on intervention outcomes, scholars have proposed various adaptation taxonomies. This paper examines how four published taxonomies retrospectively classify adaptations: the Ecological Validity Framework (EVF; Bernal et al. in J Abnorm Child Psychol 23(1):67-82, 1995), the Hybrid Prevention Program Model (HPPM; Castro et al. in Prev Sci 5(1):41-45, 2004. https://doi.org/10.1023/B:PREV.0000013980.12412.cd ), the Moore et al. (J Prim Prev 34(3):147-161, 2013. https://doi.org/10.1007/s10935-013-0303-6 ) taxonomy, and the Stirman et al. (Implement Sci 8:65, 2013. https://doi.org/10.1186/1748-5908-8-65 ) taxonomy. We used these taxonomies to classify teacher-reported adaptations made during the implementation of TOOLBOX™, a social emotional learning program implemented in 11 elementary schools during the 2014-2015 academic year. Post-implementation, 271 teachers and staff responded to an online survey that included questions about adaptation, yielding 98 adaptation descriptions provided by 42 respondents. Four raters used each taxonomy to try to classify these descriptions. We assessed the extent to which raters agreed they could classify the descriptions using each taxonomy (coverage), as well as the extent to which raters agreed on the subcategory they assigned (clarity). Results indicated variance among taxonomies, and tensions between the ideals of coverage and clarity emerged. Further studies of adaptation taxonomies as coding instruments may improve their performance, helping scholars more consistently assess adaptations and their effects on preventive intervention outcomes.
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Affiliation(s)
- Joseph N Roscoe
- Center for Prevention Research in Social Welfare, University of California Berkeley School of Social Welfare, 120 Haviland Hall, Berkeley, CA, 94720, USA.
| | - Valerie B Shapiro
- Center for Prevention Research in Social Welfare, University of California Berkeley School of Social Welfare, 120 Haviland Hall, Berkeley, CA, 94720, USA
| | - Kelly Whitaker
- School Mental Health Assessment, Research, and Training (SMART) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - B K Elizabeth Kim
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 S Olive Street, Suite 1425, Los Angeles, CA, 90015, USA
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16
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Cooper DK, Wieling E, Domenech Rodríguez MM, Garcia-Huidobro D, Baumann A, Mejia A, Le HN, Cardemil EV, Acevedo-Polakovich ID. Latinx Mental Health Scholars' Experiences with Cultural Adaptation and Implementation of Systemic Family Interventions. FAMILY PROCESS 2020; 59:492-508. [PMID: 30830697 DOI: 10.1111/famp.12433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An increasing number of culturally adapted family-level interventions address mental health disparities with marginalized populations in the United States. However, with these developments many barriers have arisen, such as challenges with degree of cultural fit, engagement, and sustainability. We conducted 12 elite phenomenological interviews with mental health scholars involved in prevention and intervention family research with various Latinx communities within and outside of the United States. These scholars discussed their experiences of overcoming barriers in their research. We used thematic analysis to code and analyze participant responses, and our findings support the gaps in previous literature and highlight potential pathways to overcoming barriers in cultural adaptation research. Themes included the need for: (a) better understanding of the intersection between culture and context; (b) community-centered approaches to addressing implementation challenges; and (c) structural changes within institutional, governmental, and political levels. We discuss implications for researchers and practitioners working with Latinx families.
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Affiliation(s)
- Daniel K Cooper
- Department of Family Social Science, University of Minnesota, St. Paul, MN
| | - Elizabeth Wieling
- Department of Family Social Science, University of Minnesota, St. Paul, MN
| | | | - Diego Garcia-Huidobro
- Department of Family Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Ana Baumann
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO
| | | | - Huynh-Nhu Le
- Department of Psychology, The George Washington University, Washington, DC
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17
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Chlebowski C, Hurwich-Reiss E, Wright B, Brookman-Frazee L. Using stakeholder perspectives to guide systematic adaptation of an autism mental health intervention for Latinx families: A qualitative study. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1194-1214. [PMID: 31816103 PMCID: PMC7261618 DOI: 10.1002/jcop.22296] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/27/2019] [Accepted: 11/18/2019] [Indexed: 05/30/2023]
Abstract
Embedded within a Hybrid Type 1 randomized effectiveness-implementation trial in publicly funded mental health services, the current study identified stakeholder recommendations to inform cultural adaptations to An Individualized Mental Health Intervention for Autism Spectrum Disorder (AIM HI) for Latinx and Spanish-speaking families. Recommendations were collected through focus groups with therapists (n = 17) and semi-structured interviews with Latinx parents (n = 29). Relevant themes were identified through a rapid assessment analysis process and thematic coding of interviews. Adaptations were classified according to the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to facilitate fit, acceptability, and sustained implementation of AIM HI and classify the content, nature, and goals of the adaptations. Recommended adaptations were classified through FRAME as tailoring training and intervention materials, changing packaging or materials, extending intervention pacing, and integrating supplemental training strategies. Goals for adaptations included improving fit for stakeholders, increasing parent engagement, and enhancing intervention effectiveness. The current study illustrates the process of embedding an iterative process of intervention adaptation within a hybrid effectiveness-implementation trial. The next steps in this study are to integrate findings with implementation process data from the parent trial to develop a cultural enhancement to AIM HI and test the enhancement in a Hybrid Type 3 implementation-effectiveness trial.
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Affiliation(s)
- Colby Chlebowski
- Department of Psychiatry, University of California San Diego, San Diego, California
- Child and Adolescent Services Research Center, San Diego, CA
| | - Eliana Hurwich-Reiss
- Department of Psychiatry, University of California San Diego, San Diego, California
- Child and Adolescent Services Research Center, San Diego, CA
| | - Blanche Wright
- Department of Psychology, University of California Los Angeles, Los Angeles, California
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California San Diego, San Diego, California
- Child and Adolescent Services Research Center, San Diego, CA
- Autism Discovery Institute, Rady Children's Hospital, San Diego, CA
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18
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Hasson H, Gröndal H, Rundgren ÅH, Avby G, Uvhagen H, von Thiele Schwarz U. How can evidence-based interventions give the best value for users in social services? Balance between adherence and adaptations: a study protocol. Implement Sci Commun 2020; 1:15. [PMID: 32885177 PMCID: PMC7427905 DOI: 10.1186/s43058-020-00005-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Using evidence-based interventions (EBIs) is a basic premise of contemporary social services (e.g., child and family social services). However, EBIs seldom fit seamlessly into a specific setting but often need to be adapted. Although some adaptions might be necessary, they can cause interventions to be less effective or even unsafe. The challenge of balancing adherence and adaptations when using EBIs is often referred to as the adherence and adaptation dilemma. Although the current literature identifies professionals’ management of this dilemma as problematic, it offers little practical guidance for professionals. This research aims to investigate how the adherence and adaptation dilemma is handled in social services and to explore how structured decision support can impact the management of the dilemma. Methods The design is a prospective, longitudinal intervention with a focus on the feasibility and usefulness of the structured decision support. The project is a collaboration between academic researchers, embedded researchers at three research and development units, and social service organizations. A multi-method data collection will be employed. Initially, a scoping review will be performed, and the results will be used in the development of a structured decision support. The decision support will be further developed and tested during a series of workshops with social service professionals. Different forms of data—focus group interviews, questionnaires, and documentation—will be used on several occasions to evaluate the impact of the structured decision support. Qualitative and quantitative analysis will be performed and usefulness for practice prioritized throughout the study. Discussion The study will contribute with knowledge on how the adherence and adaption dilemma is handled and experienced by social service professionals. Most importantly, the study will generate rich empirical data on how a structured decision support impacts professionals’ management of adherence and adaptions. The goal is to produce more strategic and context-sensitive implementation of EBIs in social service, which will increase value for service users.
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Affiliation(s)
- Henna Hasson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-171 77 Stockholm, Sweden.,Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm County Council, SE-171 29 Stockholm, Sweden
| | - Hedvig Gröndal
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Åsa Hedberg Rundgren
- Stockholm Gerontology Research Center, Stiftelsen Stockholms läns Äldrecentrum, Sveavägen 155, 113 46 Stockholm, Sweden
| | - Gunilla Avby
- FoU Nordväst, Research and Development Center for social services in northwestern Stockholm County Council, Oppegårdsstråket 12, SE-191 86 Sollentuna, Sweden.,Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Håkan Uvhagen
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-171 77 Stockholm, Sweden.,Stockholm Research and Development Unit for Elderly Persons (FoU nu), Stockholm County Council, 177 31 Järfälla, Sweden
| | - Ulrica von Thiele Schwarz
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-171 77 Stockholm, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23 Västerås, Sweden
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19
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Fagan AA, Bumbarger BK, Barth RP, Bradshaw CP, Cooper BR, Supplee LH, Walker DK. Scaling up Evidence-Based Interventions in US Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:1147-1168. [PMID: 31444621 PMCID: PMC6881430 DOI: 10.1007/s11121-019-01048-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A number of programs, policies, and practices have been tested using rigorous scientific methods and shown to prevent behavioral health problems (Catalano et al., Lancet 379:1653-1664, 2012; National Research Council and Institute of Medicine, 2009). Yet these evidence-based interventions (EBIs) are not widely used in public systems, and they have limited reach (Glasgow et al., American Journal of Public Health 102:1274-1281, 2012; National Research Council and Institute of Medicine 2009; Prinz and Sanders, Clinical Psychology Review 27:739-749, 2007). To address this challenge and improve public health and well-being at a population level, the Society for Prevention Research (SPR) formed the Mapping Advances in Prevention Science (MAPS) IV Translation Research Task Force, which considered ways to scale up EBIs in five public systems: behavioral health, child welfare, education, juvenile justice, and public health. After reviewing other efforts to scale up EBIs in public systems, a common set of factors were identified as affecting scale-up in all five systems. The most important factor was the degree to which these systems enacted public policies (i.e., statutes, regulations, and guidance) requiring or recommending EBIs and provided public funds for EBIs. Across systems, other facilitators of scale-up were creating EBIs that are ready for scale-up, public awareness of and support for EBIs, community engagement and capacity to implement EBIs, leadership support for EBIs, a skilled workforce capable of delivering EBIs, and data monitoring and evaluation capacity. It was concluded that the following actions are needed to significantly increase EBI scale-up in public systems: (1) provide more public policies and funding to support the creation, testing, and scaling up of EBIs; (2) develop and evaluate specific frameworks that address systems level barriers impeding EBI scale-up; and (3) promote public support for EBIs, community capacity to implement EBIs at scale, and partnerships between community stakeholders, policy makers, practitioners, and scientists within and across systems.
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Affiliation(s)
- Abigail A Fagan
- Department of Sociology, Criminology & Law, University of Florida, 3362 Turlington Hall, P.O. Box 117330, Gainesville, FL, 32611-7330, USA.
| | | | - Richard P Barth
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD, USA
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20
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Wiltsey Stirman S, Baumann AA, Miller CJ. The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implement Sci 2019; 14:58. [PMID: 31171014 PMCID: PMC6554895 DOI: 10.1186/s13012-019-0898-y] [Citation(s) in RCA: 517] [Impact Index Per Article: 103.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This paper describes the process and results of a refinement of a framework to characterize modifications to interventions. The original version did not fully capture several aspects of modification and adaptation that may be important to document and report. Additionally, the earlier framework did not include a way to differentiate cultural adaptation from adaptations made for other reasons. Reporting additional elements will allow for a more precise understanding of modifications, the process of modifying or adapting, and the relationship between different forms of modification and subsequent health and implementation outcomes. DISCUSSION We employed a multifaceted approach to develop the updated FRAME involving coding documents identified through a literature review, rapid coding of qualitative interviews, and a refinement process informed by multiple stakeholders. The updated FRAME expands upon Stirman et al.'s original framework by adding components of modification to report: (1) when and how in the implementation process the modification was made, (2) whether the modification was planned/proactive (i.e., an adaptation) or unplanned/reactive, (3) who determined that the modification should be made, (4) what is modified, (5) at what level of delivery the modification is made, (6) type or nature of context or content-level modifications, (7) the extent to which the modification is fidelity-consistent, and (8) the reasons for the modification, including (a) the intent or goal of the modification (e.g., to reduce costs) and (b) contextual factors that influenced the decision. Methods of using the framework to assess modifications are outlined, along with their strengths and weaknesses, and considerations for research to validate these measurement strategies. CONCLUSION The updated FRAME includes consideration of when and how modifications occurred, whether it was planned or unplanned, relationship to fidelity, and reasons and goals for modification. This tool that can be used to support research on the timing, nature, goals and reasons for, and impact of modifications to evidence-based interventions.
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Affiliation(s)
- Shannon Wiltsey Stirman
- National Center for PTSD and Stanford University, 795 Willow Road NC-PTSD, Menlo Park, CA 94025 USA
| | - Ana A. Baumann
- Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130 USA
| | - Christopher J. Miller
- Center for Healthcare Organization and Implementation Research (CHOIR),VA Boston Healthcare System, Boston, MA 02130 USA
- Harvard Medical School Department of Psychiatry, Boston, MA 02115 USA
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21
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Dyson MW, Chlebowski C, Brookman-Frazee L. Therapists' Adaptations to an Intervention to Reduce Challenging Behaviors in Children with Autism Spectrum Disorder in Publicly Funded Mental Health Services. J Autism Dev Disord 2019; 49:924-934. [PMID: 30368628 DOI: 10.1007/s10803-018-3795-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Publicly funded mental health services play an important role in serving children with autism spectrum disorder (ASD). Previous research indicates a high likelihood of adaptations when therapists deliver evidence based practices to non-ASD populations, though less is known about therapists' use of adaptations for children with ASD receiving mental health services. The current study uses a mixed quantitative and qualitative approach to characterize the types and reasons therapists adapted a clinical intervention [An Individualized Mental Health Intervention for Children with ASD (AIM HI)] for delivery with clinically complex children with ASD served in publicly funded mental health settings and identify therapist characteristics that predict use of adaptations. The most common adaptations were characterized as augmenting AIM HI and were done to individualize the intervention to fit with therapeutic style, increase caregiver participation, and address clients' and caregivers' needs and functioning. No therapist characteristics emerged as significant predictors of adaptations. Results suggest that therapists' adaptations were largely consistent with the AIM HI protocol while individualizing the model to address the complex needs of youth with ASD.
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Affiliation(s)
- Margaret W Dyson
- Department of Psychiatry, University of California, San Diego, CA, USA. .,Child and Adolescent Services Research Center (CASRC), 3020 Children's Way, MC 5033, San Diego, CA, 92123, USA.
| | - Colby Chlebowski
- Department of Psychiatry, University of California, San Diego, CA, USA.,Child and Adolescent Services Research Center (CASRC), 3020 Children's Way, MC 5033, San Diego, CA, 92123, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, CA, USA.,Child and Adolescent Services Research Center (CASRC), 3020 Children's Way, MC 5033, San Diego, CA, 92123, USA
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22
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Hill LG, Cooper BR, Parker LA. Qualitative Comparative Analysis: A Mixed-Method Tool for Complex Implementation Questions. J Prim Prev 2019; 40:69-87. [DOI: 10.1007/s10935-019-00536-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Escoffery C, Lebow-Skelley E, Udelson H, Böing EA, Wood R, Fernandez ME, Mullen PD. A scoping study of frameworks for adapting public health evidence-based interventions. Transl Behav Med 2019; 9:1-10. [PMID: 29346635 PMCID: PMC6305563 DOI: 10.1093/tbm/ibx067] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Evidence-based public health translation of research to practice is essential to improve the public's health. Dissemination and implementation researchers have explored what happens once practitioners adopt evidence-based interventions (EBIs) and have developed models and frameworks to describe the adaptation process. This scoping study identified and summarized adaptation frameworks in published reports and grey literature. We followed the recommended steps of a scoping study: (a) identifying the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; (e) collating, summarizing, and reporting the results; and (f) consulting with experts. We searched PubMed, PsycINFO, PsycNET, and CINAHL databases for articles referencing adaptation frameworks for public health interventions in the published and gray literature, and from reference lists of framework articles. Two reviewers independently coded the frameworks and their steps and identified common steps. We found 13 adaptation frameworks with 11 program adaptation steps: (a) assess community, (b) understand the EBI(s), (c) select the EBI, (d) consult with experts, (e) consult with stakeholders, (f) decide on needed adaptations, (g) adapt the original EBI, (h) train staff, (i) test the adapted materials, (j) implement the adapted EBI, and (k) evaluate. Eight of these steps were recommended by more than five frameworks: #1-3, 6-7, and 9-11. This study is the first to systematically identify, review, describe, and summarize frameworks for adapting EBIs. It contributes to the literature by consolidating key steps in program adaptation of EBIs and describing the associated tasks in each step.
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Affiliation(s)
- Cam Escoffery
- Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Hallie Udelson
- Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Elaine A Böing
- Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Richard Wood
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Maria E Fernandez
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Patricia D Mullen
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Escoffery C, Lebow-Skelley E, Haardoerfer R, Boing E, Udelson H, Wood R, Hartman M, Fernandez ME, Mullen PD. A systematic review of adaptations of evidence-based public health interventions globally. Implement Sci 2018; 13:125. [PMID: 30257683 PMCID: PMC6158804 DOI: 10.1186/s13012-018-0815-9] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/10/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Adaptations of evidence-based interventions (EBIs) often occur. However, little is known about the reasons for adaptation, the adaptation process, and outcomes of adapted EBIs. To address this gap, we conducted a systematic review to answer the following questions: (1) What are the reasons for and common types of adaptations being made to EBIs in community settings as reported in the published literature? (2) What steps are described in making adaptations to EBIs? and (3) What outcomes are assessed in evaluations of adapted EBIs? METHODS We conducted a systematic review of English language publications that described adaptations of public health EBIs. We searched Ovid PubMed, PsycINFO, PsycNET, and CINAHL and citations of included studies for adapted public health EBIs. We abstracted characteristics of the original and adapted populations and settings, reasons for adaptation, types of modifications, use of an adaptation framework, adaptation steps, and evaluation outcomes. RESULTS Forty-two distinct EBIs were found focusing on HIV/AIDS, mental health, substance abuse, and chronic illnesses. More than half (62%) reported on adaptations in the USA. Frequent reasons for adaptation included the need for cultural appropriateness (64.3%), focusing on a new target population (59.5%), and implementing in a new setting (57.1%). Common adaptations were content (100%), context (95.2%), cultural modifications (73.8%), and delivery (61.9%). Most study authors conducted a community assessment, prepared new materials, implemented the adapted intervention, evaluated or planned to evaluate the intervention, determined needed changes, trained staff members, and consulted experts/stakeholders. Most studies that reported an evaluation (k = 36) included behavioral outcomes (71.4%), acceptability (66.7%), fidelity (52.4%), and feasibility (52.4%). Fewer measured adoption (47.6%) and changes in practice (21.4%). CONCLUSIONS These findings advance our understanding of the patterns and effects of modifications of EBIs that are reported in published studies and suggest areas of further research to understand and guide the adaptation process. Furthermore, findings can inform better reporting of adapted EBIs and inform capacity building efforts to assist health professionals in adapting EBIs.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - E. Lebow-Skelley
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - R. Haardoerfer
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - E. Boing
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - H. Udelson
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - R. Wood
- University of Texas School of Public Health, 7000 Fannin, Ste 2522, Houston, TX 77030 USA
| | - M. Hartman
- University of Texas School of Public Health, 7000 Fannin, Ste 2522, Houston, TX 77030 USA
| | - M. E. Fernandez
- University of Texas School of Public Health, 7000 Fannin, Ste 2522, Houston, TX 77030 USA
| | - P. D. Mullen
- University of Texas School of Public Health, 7000 Fannin, Ste 2522, Houston, TX 77030 USA
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von Thiele Schwarz U, Förberg U, Sundell K, Hasson H. Colliding ideals - an interview study of how intervention researchers address adherence and adaptations in replication studies. BMC Med Res Methodol 2018; 18:36. [PMID: 29739337 PMCID: PMC5941334 DOI: 10.1186/s12874-018-0496-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 04/30/2018] [Indexed: 11/22/2022] Open
Abstract
Background For an intervention to be considered evidence-based, findings need to be replicated. When this is done in new contexts (e.g., a new country), adaptations may be needed. Yet, we know little about how researchers approach this. This study aims to explore how researchers reason about adaptations and adherence when conducting replication studies, describe what adaptations they make and how these are reported in scientific journals. Methods This was an interview study conducted in 2014 with principal investigators of Swedish replication studies reporting adaptations to an intervention from another country. Studies (n = 36) were identified through a database of 139 Swedish psychosocial and psychological intervention studies. Twenty of the 21 principal investigators agreed to participate in semi-structured telephone interviews, covering 33 interventions. Manifest content analysis was used to identify types of adaptations, and qualitative content analysis was used to explore reasoning and reporting of adaptations and adherence. Results The most common adaptation was adding components and modifying the content to the target population and setting. When reasoning about adaptations and adherence, the researchers were influenced by four main factors: whether their implicit aim was to replicate or improve an intervention; the nature of evidence outlying the intervention such as manuals, theories and core components; the nature of the context, including approaches to cultural adaptations and constraints in delivering the intervention; and the needs of clients and professionals. Reporting of adaptations in scientific journals involved a conflict between transparency and practical concerns such as word count. Conclusions Researchers responsible for replicating interventions in a new country face colliding ideals when trying to protect the internal validity of the study while considering adaptations to ensure that the intervention fits into the context. Implicit assumptions about the role of replication seemed to influence how this conflict was resolved. Some emphasised direct replications as central in the knowledge accumulation process (stressing adherence). Others assumed that interventions generally need to be improved, giving room for adaptations and reflecting an incremental approach to knowledge accumulation. This has implications for design and reporting of intervention studies as well as for how findings across studies are synthesised.
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Affiliation(s)
- Ulrica von Thiele Schwarz
- Medical Management Centre, Department of Learning, Informatics, Management, & Ethics, Karolinska Institutet, Stockholm, Sweden. .,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
| | - Ulrika Förberg
- Medical Management Centre, Department of Learning, Informatics, Management, & Ethics, Karolinska Institutet, Stockholm, Sweden.,Children's and Women's Health Theme, Karolinska University Hospital, and Department of Women and Child Health, Karolinska Institutet, Stockholm, Sweden
| | - Knut Sundell
- Medical Management Centre, Department of Learning, Informatics, Management, & Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Henna Hasson
- Medical Management Centre, Department of Learning, Informatics, Management, & Ethics, Karolinska Institutet, Stockholm, Sweden.,Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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Stirman SW, Gamarra J, Bartlett B, Calloway A, Gutner C. Empirical Examinations of Modifications and Adaptations to Evidence-Based Psychotherapies: Methodologies, Impact, and Future Directions. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2017; 24:396-420. [PMID: 29593372 PMCID: PMC5866913 DOI: 10.1111/cpsp.12218] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This review describes methods used to examine the modifications and adaptations to evidence-based psychological treatments (EBPTs), assesses what is known about the impact of modifications and adaptations to EBPTs, and makes recommendations for future research and clinical care. One hundred eight primary studies and three meta-analyses were identified. All studies examined planned adaptations, and many simultaneously investigated multiple types of adaptations. With the exception of studies on adding or removing specific EBPT elements, few studies compared adapted EBPTs to the original protocols. There was little evidence that adaptations in the studies were detrimental, but there was also limited consistent evidence that adapted protocols outperformed the original protocols, with the exception of adding components to EBPTs. Implications for EBPT delivery and future research are discussed.
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Affiliation(s)
| | | | | | | | - Cassidy Gutner
- National Center for PTSD, VA Boston Healthcare System, and Boston University
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Barrera M, Berkel C, Castro FG. Directions for the Advancement of Culturally Adapted Preventive Interventions: Local Adaptations, Engagement, and Sustainability. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 18:640-648. [PMID: 27591993 PMCID: PMC7678089 DOI: 10.1007/s11121-016-0705-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To advance the implementation and dissemination of culturally adapted interventions to diverse populations, greater attention should be devoted to three underdeveloped topics: (a) local adaptations of interventions when they are implemented in community settings, (b) participant engagement, and (c) the sustainability of adapted interventions. Several typologies have been developed for studying local adaptations, and some research indicates that such adaptations might add to intervention effectiveness. There is suggestive evidence of ethnocultural group disparities in intervention engagement and in the success of efforts to boost engagement. Theory and limited data indicate that interventions' flexibility and fit with organizational culture and resources can be achieved through cultural adaptations. Furthermore, those adaptations should be associated with sustainability, but research has yet to test that hypothesis adequately. Several recommendations are made for advancing culturally adapted interventions through additional research on local adaptations during implementation, the many facets of participant engagement, and sustainability.
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Affiliation(s)
- Manuel Barrera
- Psychology Department, Arizona State University, Box 871104, Tempe, AZ, 85287-1104, USA.
| | - Cady Berkel
- Psychology Department, Arizona State University, Box 871104, Tempe, AZ, 85287-1104, USA
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Lau A, Barnett M, Stadnick N, Saifan D, Regan J, Wiltsey Stirman S, Roesch S, Brookman-Frazee L. Therapist report of adaptations to delivery of evidence-based practices within a system-driven reform of publicly funded children's mental health services. J Consult Clin Psychol 2017; 85:664-675. [PMID: 28471210 PMCID: PMC5501960 DOI: 10.1037/ccp0000215] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined clinical adaptations reported by community therapists to multiple evidence-based practices (EBPs) currently implemented in children's mental health services. Based on an item set informed by Stirman and colleagues' model (2015), 2 factors emerged describing Augmenting adaptations and Reducing/Reordering adaptations. We used multilevel modeling to examine therapist- and practice-level predictors of therapist reports of each type of adaptation. METHOD Data were drawn from an online survey, including a novel therapist report measure of EBP adaptations, completed by 572 therapists (89.2% female, Mage = 37.08 years, 33.4% non-Hispanic White) delivering EBPs in the context of a system-driven, fiscally mandated implementation effort. RESULTS Analyses revealed that the 2 types of therapist adaptations (Augmenting and Reducing/Reordering) could be readily discriminated, with therapists reporting significantly more Augmenting than Reducing/Reordering adaptations. Therapists of Hispanic/Latino ethnicity and with fewer years of experience reported more extensive Augmenting adaptations, but no therapist background characteristics were associated with Reducing/Reordering adaptations. Therapists' general attitudes that EBPs diverged from their personal approach to therapy were associated with reporting more Augmenting and Reducing/Reordering adaptations. In contrast, negative perceptions toward the specific EBP predicted Reducing/Reordering adaptations, but not Augmenting adaptations. CONCLUSIONS Community therapist reports suggest that most adaptations undertaken involve engaging with the practice to augment the fit of the EBPs for local contexts; however, when practices were perceived negatively, therapists were more likely to make adaptations reducing or rearranging components. (PsycINFO Database Record
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Affiliation(s)
- Anna Lau
- Department of Psychology, University of California, Los Angeles
| | - Miya Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara
| | - Nicole Stadnick
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego
| | - Dana Saifan
- Department of Psychology, University of California, Los Angeles
| | | | | | - Scott Roesch
- Department of Psychology, San Diego State University
| | - Lauren Brookman-Frazee
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego
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Davies EL. “The monster of the month”: teachers’ views about alcohol within personal, social, health, and economic education (PSHE) in schools. DRUGS AND ALCOHOL TODAY 2016. [DOI: 10.1108/dat-02-2016-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose
There is a lack of evidence for effective school-based prevention programmes to reduce alcohol misuse in adolescents. The purpose of this paper is to explore teacher’s views about alcohol education in secondary schools in order to inform the subsequent development of new educational and intervention measures.
Design/methodology/approach
Semi-structured interviews were conducted with nine female teachers from a range of schools who had responsibility for designing and delivering personal social, health, and economic education (PSHE).
Findings
Three main themes were identified in a thematic analysis of the interview transcripts. The themes demonstrated the importance of PSHE to these teachers, who faced challenges in delivering a comprehensive enough curriculum. Alcohol unit knowledge and responsible drinking were priorities for the teachers. However, given the many pressures faced by young people, alcohol could be viewed as just one challenge amongst many.
Research limitations/implications
Interventions may be seen as too compartmentalised by teachers if they fail to address the wider concerns of adolescents. Intervention developers should consider gaining input from teachers on the content of their programmes prior to running a trial to enhance feasibility and acceptability.
Originality/value
There are few studies that have explored what teachers think about alcohol education in general or about the content of specific interventions prior to their implementation. This study adds their voice to the literature and highlights the importance of considering the views and first hand experiences when developing new alcohol interventions aimed at adolescents.
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