Development of a framework and coding system for modifications and adaptations of evidence-based interventions

Table 2 Modifications and adaptations made to programs and interventions

Decision maker (overall kappa = 0.80, n = 261)	Frequency	% of total modifications
Individual practitioner^a	55	21
Team or group of practitioners	24	9
Administrator	2	<1
Researcher	22	8
Intervention developer or purveyor^b	70	27
Coalition of stakeholders^c	76	29
Unknown/insufficient information	12	5
Contextual modifications (overall kappa = 1.00, n = 41)	Frequency	% of contextual modifications	% of total modifications
Format	8	25	3
Setting	6	19	2
Personnel	10	3	4
Population	8	25	3
Training and evaluation Processes	9	-	3
Content modifications (n = 217)	Frequency	% of content modifications	% of total modifications
Level (overall kappa = 0.79)
Individual recipient	14	6	5
Cohort	14	6	5
Population^d	71	33	28
Provider/facilitator	20	9	8
Unit^e	38	18	15
Hospital/organization	22	10	9
Network/community^f	38	18	15
Nature of modification (overall kappa = 0.87)
Tailoring/tweaking/refining^f	73	34	28
Adding elements^g	62	29	24
Removing elements^g	33	15	13
Shortening/condensing^h	17	8	7
Lengthening/extending	12	6	5
Substituting elements	5	2	2
Re-ordering elements	4	2	2
Integrating another approach into the intervention	3	1	1
Integrating the intervention into another approach	2	1	1
Departing from the intervention (“Drift”)	1	<1	<1
Loosening structure	1	<1	<1
Repeating elements	1	<1	<1

Note: Three modifications that were identified in the articles did not contain sufficient detail to be rated.
^aRaw agreement for this category was 100%.
^bRaw agreement for this category was 82%.
^cRaw agreement for this category was 73%.
^dRaw agreement for this category was 87%.
^eRaw agreement for this category was 67%.
^fRaw agreement for this category was 91%.
^gRaw agreement for these categories was 83%.
^hRaw agreement for this category was 86%.

ISSN: 1748-5908