Volume 10 Supplement 1

7th Annual Conference on the Science of Dissemination and Implementation in Health

Open Access

Adaptation reconceptualized: "retrofitting" ongoing organizational activities with essential elements of evidence-based interventions

  • Mary Janevic1,
  • Tyra Bryant-Stephens2,
  • Marielena Lara3,
  • Yvonne Ohadike4,
  • Victoria Persky5,
  • Gilberto Ramos-Valencia6,
  • Shelley Stoll1Email author,
  • Kimberly Uyeda7 and
  • Floyd Malveaux4
Implementation Science201510(Suppl 1):A35

https://doi.org/10.1186/1748-5908-10-S1-A35

Published: 14 August 2015

Background

Evidence-based interventions (EBIs) are sometimes implemented in contexts where ongoing program activities overlap with EBI components. As part of a comprehensive cross-site evaluation, we examined the grant-funded implementation of the EBI "Yes We Can" (YWC), a medical-social model for pediatric asthma care coordination, in four distinct settings. Assessment indicated that some sites already had in place one or more activities that were similar to YWC components. We examined why and to what extent organizations "retrofitted" existing activities to align with YWC core elements, and how retrofitting influenced implementation and maintenance.

Methods

YWC essential elements were identified through a literature search and interview with the developer. We obtained information about ongoing organizational activities and subsequent adaptations from in-depth interviews with site leaders and field staff, in which factors affecting implementation [1] were also probed. Detailed interview notes were coded and analyzed, using NVivo.

Results

The extent of retrofitting ranged from one extreme, where the EBI was adopted where no similar activities existed, to the other, where a well-established, successful program was improved by adopting select components of YWC. Key informants noted the value of keeping "what already works" in their unique context while enhancing ongoing services by adding EBI components. Factors affecting implementation highlighted the conditions that make retrofitting a rational and feasible approach; e.g., a flexible, complex intervention that allows for significant adaptations and the opportunity to capitalize on existing political support for program activities. In this small sample, sites that retrofitted ongoing activities were better able to maintain EBI components after funding ended.

Conclusion

Retrofitting reflects the reality of how some EBIs are adapted, and may promote successful maintenance. Future research can explore systematically how retrofitting affects other key outcomes such as adoption, reach, and effectiveness.

Supported by the Merck Childhood Asthma Network.

Authors’ Affiliations

(1)
Department of Health Behavior and Health Education, University of Michigan
(2)
Children's Hospital of Philadelphia
(3)
Rand Corporation
(4)
Merck Childhood Asthma Network
(5)
Division of Epidemiology and Biostatistics, University of Illinois at Chicago
(6)
Department of Biostatistics and Epidemiology, University of Puerto Rico
(7)
Student Medical Services, Los Angeles Unified School District

References

  1. Durlak JA, DuPre EP: Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008, 41 (3-4): 327-350. 10.1007/s10464-008-9165-0.View ArticlePubMedGoogle Scholar

Copyright

© Janevic et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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