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Table 3 FRAME constructs and additions/clarifications for this study

From: Methods for capturing and analyzing adaptations: implications for implementation research

FRAME element FRAME component choices (as noted from the model) Use of FRAME components for this study
When did the modification occur? • Pre-implementation/planning
• Implementation
• Scale-up
• Maintenance/sustainment
• As our data were primarily from the implementation phase, we did not see data categorized as pre-implementation, scale-up, or maintenance
• Split pre-implementation and implementation into “When did it occur” and “For how long did it occur” to distinguish permanence of adaptation
Were adaptations planned? • Planned/proactive (proactive adaptation)
• Planned/reactive (reactive adaptation)
• No modifications
Who participated in the decision to modify? • Political leaders
• Program leaders
• Funders
• Administrator
• Program manager
• Intervention developer/purveyor
• Researcher
• Treatment/intervention team
• Individual practitioner
• Community members
• Recipients
• Changed to reflect relevant roles (researchers, patients, study-involved staff at practice, non-study-involved staff at practice, both researchers and practice staff, other)
What was modified? • Content
• Contextual
• Training and evaluation
• Implementation and scale-up activities
• Expanded to reflect study changes (program content, who is involved, recruitment, time devoted, follow-up or tracking, scheduling, reimbursement, resources, other)
At what level of delivery (for whom/what is the modification made?) • Individual
• Target intervention group
• Cohort of individuals
• Individual practitioner
• Clinic/unit level
• Organization
• Network system/community
• Modified slightly to reflect relevant players (individual- patient, individual- practice member, practice, study-initiated for intervention arm, study-initiated for entire project)
Contextual modifications are made to which of the following? • Format
• Setting
• Personnel
• Population
• Added N/A option
What is the nature of the context modification? • 15 selection choices including tailoring, packaging, loosening structure, and “drift” • Answer choices did not fit well with our study, so we did not categorize, opting to capture as part of the open-ended “What was adapted”
Relationship fidelity/core elements? • Fidelity consistent
• Fidelity inconsistent
• As we were comparing two study arms, further expanded “Fidelity inconsistent” to outside protocol (condition specific) for when one study arm was altered to look more similar to the other study arm
• Added “Became within protocol” for situations where data reflected an outside of protocol change that was brought back within protocol
What was the goal? • Increase reach or engagement
• Increase retention
• Improve feasibility
• Improve fit with recipient
• Address cultural factors
• Improve effectiveness/outcomes
• Reduce cost
• Increase satisfaction
• “Address cultural factors” was merged with “Improve fit with recipient” due to similarities and low number of cultural changes
• Added “Outside factors/just happened” and “Other or N/A”
Reasons (sociopolitical, organization/setting, provider, recipient) • Sociopolitical
• Organization/setting
• Provider
• Recipient
• Not categorized, captured as part of open-ended “Why was it adapted” with free text
Not in FRAME
What we added (not in FRAME) • N/A • Free text around implications for time, cost, expertise, etc. (i.e., the impact of the adaptation)
• Free text around what made the change go well or not go well