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Table 1 Constructs from source frameworks, areas of overlap, modifications to existing frameworks, and reason for modifications

From: Towards a comprehensive model for understanding adaptations’ impact: the model for adaptation design and impact (MADI)

Construct and source framework (Stirman et al., Moore et al., or Proctor et al.) Overlapping constructs Modifications/additions to existing frameworks (in bold font) Reason for modifications
Stirman: When did the modification occur? (Stirman)
• Pre-implementation/planning/pilot
• Implementation
• Scale up
• Maintenance/sustainment
None None N/A
Stirman: Were adaptations planned?
• Planned/proactive (proactive)
• Planned/reactive (reactive)
Moore: Timing
• Whether the adaptation was proactive (occurring before implementation due to anticipated obstacles) or reactive (during implementation, due to unanticipated obstacles)
Were adaptations systematic/unsystematic and proactive/reactive?
Systematic and proactive
Systematic and reactive
Non-systematic and proactive
Non-systematic and reactive (modification)
Revised wording to remove concept of “planned” and replace with concept of “systematic.” This emphasizes the importance of how the adaptation was made (i.e., was it done using a systematic process), in addition to whether the adaptation was proactive (made due to an anticipated obstacle) or reactive (due to unanticipated challenges). This distinction is important as the assumption is that reactive adaptations are more likely to be non-systematic, impromptu, and less likely to be aligned with core functions of the intervention. However, our conceptualization allows for an understanding that reactive adaptations can still be made in a way that is systematic.
Stirman: Who participated in the decision to modify?
• Political leaders, program leader, funder, administrator, program manager, intervention developer/purveyor, researcher, treatment/intervention team, individual practitioners, community members, recipients
None None N/A
Stirman: What was modified?
• Content
• Contextual
• Training/evaluation
• Implementation and scale-up activities
None None N/A
Stirman: At what level (for whom/what) is the modification made?
• Individual, target intervention group, cohort/individuals that share a characteristic, individual practitioner, clinic/unit level, organization, network system/community
None None N/A
Stirman: Contextual modifications?
• Format
• Setting
• Personnel
• Population
None None N/A
Stirman: What is the nature of the content modification?
• Tailoring/tweaking/refining, changes in packaging or materials, adding elements, skipping/removing elements, shortening/condensing (pacing/timing), lengthening/extending (pacing/timing), substituting, re-ordering, spreading, integrating into another framework, integrating into another treatment, repeating, loosening, departing from intervention followed by return to protocol (drift), drift without returning to protocol
None None N/A
Stirman: Relationship to core elements/fidelity?
• Fidelity consistent/core elements preserved
• Fidelity inconsistent/core elements changed
• Unknown
Moore: Valence
• Whether the adaptation aligned with the program’s theory/goals and thus were likely to have a positive/neutral/negative impact
Are adaptations aligned with core functions?
• Fidelity consistent/core functions preserved
• Fidelity inconsistent/core functions changed
• Unknown
Removed references to “core elements” and instead focused on “core functions” due to recent publications in the literature which advocate for use of the term functions as it is the functions intervention components serve that is often core, not their exact form [20, 21]
Stirman: What was the goal? (Stirman)
• Increase reach/engagement
• Increase retention
• Improve feasibility
• Improve fit with recipients
• Address cultural factors
• Improve effectiveness/outcomes
• Reduce cost
• Increase satisfaction
Moore: Fit
• Whether the adaptation was made for philosophical fit (to align with goals of organization or culture of target population) or logistical fit (to address mismatches in capacity, such as resources, time)
What was the goal?
Improve likelihood of adoption
• Improve feasibility
• Improve fit with recipients (appropriateness)
o Address cultural factors
• Increase satisfaction (acceptability)
• Reduce cost
• Increase reach/engagement (penetration)
Improve fidelity
• Increase retention
Improve sustainability
• Improve intervention effectiveness/outcomes
No goal
Added in/re-labeled additional mplementation outcomes (penetration, fidelity, sustainability, adoption, appropriateness, acceptability) to align this construct with Proctor’s framework. Also added in “no goal” for instances where an adaptation was made without a stated intended purpose or goal.
Stirman: Reasons for adaptation?
• Sociopolitical (e.g., existing laws, political climate)
• Organization/setting (e.g., available resources, competing demands)
• Provider (e.g., race, first spoken languages, preferences, clinical judgement)
• Recipient (e.g., race, access to resources, literacy, motivation/readiness)
None None N/A
Proctor: Implementation outcomes
• Acceptability
• Adoption
• Appropriateness
• Cost
• Feasibility
• Fidelity
• Penetration
• Sustainability
None None N/A
Proctor: Service/client outcomes (Proctor)
• Service outcomes: efficiency, safety, effectiveness, equity, patient-centeredness, timeliness
• Client outcomes: satisfaction, function, symptomatology
None Called “intervention outcomes” Re-labeled to provide an overarching category for both service and client outcomes.