Implementation and Adaptation Guide
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Secrets to Successful Adaptation
Evidence-based interventions and the implementation strategies you use are not one-size-fits-all. You may have to adapt them to better fit the resources and culture at your local settings and the patients you serve. Adaptations may involve adding, taking away, expanding, simplifying, or replacing components of the intervention and/or your implementation strategy. Better fit will allow for more successful implementation, sustained use, and sustained outcomes.
Adaptations might be made at different phases of your program. You might make certain changes prior to implementing a program based on your knowledge of the local setting, patients, resources, and processes. Additional changes might be necessary while you are implementing the program to address emerging issues. These might be informed by a formal ongoing, mid-course evaluation of the program as well as feedback from the frontline staff implementing the program. Finally, if you are implementing in multiple sites, you might choose to make changes to the program after implementation is complete in one site before trying it in (or spreading it to) another site.
Adaptations can be made for various reasons and can be classified as adaptation that intend to improve:
❯ Patient reach
❯ Adoption by frontline staff, clinics, and health systems
❯ Implementation of the program
❯ Effectiveness of the program
❯ Sustained use of the program
Some adaptations will be made after assessing information that is available to you and planning based on this information (i.e., planned adaptations). In other cases adaptations might be made on the spot to address an issue that arises during program implementation. While planned adaptations generally lead to more consistent outcomes, unplanned adaptations do happen and as long as documented can also be used to inform program evaluation.
Whatever you decide to do, it is important to document adaptations made to the intervention, implementation strategy, and context. Information on adaptations you made can help you interpret your findings and can support future sites who might want to use the intervention.
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