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Table 4 Summary of the key adaptation steps extracted from the guidance papers (n = 27)

From: Adapting evidence-informed complex population health interventions for new contexts: a systematic review of guidance

  Step name Step descriptions Implemented by…
Exploration phase 1. Initial assessment - Identify the need for a new intervention for the target population
- Conduct a multilevel needs assessment of system, process, organisation, provider, and characteristics of the target population
- Identify relevant contextual factors and community best practices
[29, 31, 32, 37, 41, 43, 45,46,47,48,49, 51,52,53, 55,56,57, 60, 63, 64, 66]
2. Intervention selection - Identify and review evidence-based interventions that address the public health problem of interest, risk behaviours, and environmental factors
- Determine whether the intervention goals and outcomes are relevant to the target population
- Determine whether the intervention content targets the population’s social and cultural values
- Judge the fit of the intervention to the problem, organisational capacity, and target population
- Select the best matching intervention
[32, 34, 38, 41, 45, 46, 48, 49, 52, 53, 55, 58, 60, 63, 64, 66]
3. Intervention exploration - Obtain the original intervention materials (e.g. statement of the goals, summary of the underlying theory of change, and/or the curriculum)
- Identify the intervention’s core components and best-practice characteristics
- Examine the theory base behind the intervention, identifying core mechanisms of change, moderators that may enhance or diminish outcomes, and any potential secondary pathways through which change might be achieved
- Determine the interventions adaptability to the new target population and setting
[32, 34, 38, 47,48,49,50,51, 57,58,59,60, 62]
Preparation phase 4. Identification of potential mismatches - Identify and categorise potential mismatches (e.g. among intervention goals, characteristics of the target population, implementation agency and/or community)
- Identify potential implementation barriers
- Identify potential barriers to participation
- Assess fidelity/adaptation concerns for the particular implementation site, i.e. by determining what core components are especial to maintain to address fidelity
[29, 32, 34, 36, 38, 41, 45, 49, 52, 53, 56, 58, 62, 63]
5. Intervention model development - Define the extent of adaptation needed
- Develop an overall logic model and timeline for adapting and implementing the intervention
- Consider how components can accommodate population characteristics, delivery system, and community context
- Explore potential ways to implement the adapted intervention and develop an implementation plan
- Draft a user-friendly manual (i.e. “package”) of the intervention
- Develop an overall implementation plan, including a strategy for achieving and measuring fidelity/adaptation balance for the selected intervention
[29, 34, 36, 41, 45,46,47,48,49,50,51,52, 57,58,59, 62, 63]
6. Establishment of networks, capacity, and infrastructure - Assess stakeholder input and potential collaborations and secure their meaningful involvement
- Assess organisational, as well as implementers’ capacity to implement the intervention
- Consult with the intervention developers, relevant organisational stakeholders, and the community to explore how they can help to shaped an implementation plan into a particular setting
- Identify and recruit potential implementers, if possible with the same ethnic background as the target population (consider working with paraprofessionals or lay health workers)
- Use community resources to increase intervention accessibility
- Build community capacity for practical sustainability
- Establish balance between community needs and scientific integrity by an iterative process among all relevant stakeholders involved in the adaptation process
[32, 36, 37, 40, 41, 45,46,47, 50, 52, 53, 56, 58,59,60, 62, 63, 66]
Implementation phase 7. Undertaking modifications - Develop an adaptation plan
- Consider adaptations that may be necessary to meet the needs of new target population, while making sure that core elements of the intervention’s programme theory are not altered
- Consider possible local adaptations to improve cultural/context fit by taking into account potential language difference of cultural sub-groups
- If applicable, develop a “mock-up” version of the adapted material, prepare design documents for adaptation, and draft user-friendly manuals of the intervention
- Consider intervention training, including training of organisation staff
- Adapt the relevant intervention components through collaborative efforts
[29, 32, 34, 37, 38, 40, 41, 43, 45,46,47,48, 52, 53, 56, 58, 60, 63, 66]
8. (Pilot) testing - Pilot test the adapted intervention components and procedures with representatives from the target group, get feedback and revise as necessary
- Monitor the fidelity of intervention delivery
[31, 32, 37, 38, 40, 41, 45, 46, 48, 50, 52, 58, 60, 63]
9. Intervention revision and implementation - Refine adaptations based on results generated in previous steps
- Synthesise stakeholder feedback and finalise the implementation plan
- Implement the adapted intervention
- Establish ongoing support, feedback and refinement
[29, 31, 37, 38, 40, 41, 45,46,47, 53, 60, 63]
Sustainment phase 10. Evaluation - Decide how to evaluate and possibly incorporate feedback from diverse stakeholder groups and develop an evaluation plan that reflects the core mechanisms of change within the original programme theory, as well as adaptations made in intervention content to accommodate the new target population
- Implement outcome evaluation
- Provide routine, ongoing supervision (including quality assurance)
- Assess acceptance of and participants’ engagement in the adapted intervention
- Revise the intervention by adopting effective or dropping ineffective adaptations
[31, 32, 38, 41, 43, 45,46,47, 49, 50, 53, 56, 58, 63, 66]
11. Maintenance and evolution - Establish a wide-scale dissemination of the adapted intervention, given the intervention is successful and is embraced by the community
- Develop training systems to widen the dissemination (e.g. train future implementers in the adapted version of the intervention)
- Implement an ongoing re-assessment by circularising the process and outcome research results and the lessons learned in the transportation of the evidence-based intervention
[29, 41, 53, 66]