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

Abstract

BackgroundAdapting interventions that have worked elsewhere can save resources associated with developing new interventions for each specific context. While a developing body of evidence shows benefits of adapted interventions compared with interventions transported without adaptation, there are also examples of interventions which have been extensively adapted, yet have not worked in the new context. Decisions on when, to what extent, and how to adapt interventions therefore are not straightforward, particularly when conceptualising intervention effects as contingent upon contextual interactions in complex systems. No guidance currently addresses these questions comprehensively. To inform development of an overarching guidance on adaptation of complex population health interventions, this systematic review synthesises the content of the existing guidance papers.MethodsWe searched for papers published between January 2000 and October 2018 in 7 bibliographic databases. We used citation tracking and contacted authors and experts to locate further papers. We double screened all the identified records. We extracted data into the following categories: descriptive information, key concepts and definitions, rationale for adaptation, aspects of adaptation, process of adaptation, evaluating and reporting adapted interventions. Data extraction was conducted independently by two reviewers, and retrieved data were synthesised thematically within pre-specified and emergent categories.ResultsWe retrieved 6694 unique records. Thirty-eight papers were included in the review representing 35 sources of guidance. Most papers were developed in the USA in the context of implementing evidence-informed interventions among different population groups within the country, such as minority populations. We found much agreement on how the papers defined key concepts, aims, and procedures of adaptation, including involvement of key stakeholders, but also identified gaps in scope, conceptualisation, and operationalisation in several categories.ConclusionsOur review found limitations that should be addressed in future guidance on adaptation. Specifically, future guidance needs to be reflective of adaptations in the context of transferring interventions across countries, including macro- (e.g. national-) level interventions, better theorise the role of intervention mechanisms and contextual interactions in the replicability of effects and accordingly conceptualise key concepts, such as fidelity to intervention functions, and finally, suggest evidence-informed strategies for adaptation re-evaluation and reporting.Trial registrationPROSPERO 2018, CRD42018112714.

Cultural adaptation of ‘Healthy Dads, Healthy Kids’ for Hispanic families: applying the ecological validity model

“…This paper describes a systematic approach to culturally adapt the HDHK program for a new population and context from those targeted by the original HDHK program. As recommended by others [32,33], stakeholder input was critical in informing the adaptation. Stakeholders for this project included representatives of the target population (Family Panel) with similar inclusion and exclusion criteria as for the planned feasibility trial.…”

“…Additionally, the benefit of nutrition, PA and screen media behavior changes for the whole family was emphasized to a greater extent to further operationalize familism. Core components of HDHK were identified a priori and retained as recommended by guidelines for program adaptation [32,33]. However, the core component of reciprocal reinforcement was adapted to address cultural concerns of children telling their father what to do.…”

“…Adapting existing evidence-based interventions for different contexts has received greater attention in recent years. Since the Papás Saludables, Niños Saludables project was started, two groups have provided guidance on best practices for systematically adapting existing health promotion programs for new contexts [32,33]. Both guidelines emphasize the critical role understanding contexts has on delivering programs that are appropriate, implementable, effective and sustainable for new target groups.…”

“…However, to our knowledge, utilizing an established, comprehensive framework to inform the adaptation of family based obesity interventions to help ensure external validity of evidence-based programs when targeting new populations has not previously been done. The obesity prevention, nutrition, and PA fields should consider applying systematic approaches [32,33] when adapting evidence-based programs to any new target population.…”

Scale-Up and Scale-Out of a Gender-Sensitized Weight Management and Healthy Living Program Delivered to Overweight Men via Professional Sports Clubs: The Wider Implementation of Football Fans in Training (FFIT)

“…Movsisyan et al noted that: "decisions on when, to what extent, and how to adapt interventions are not straightforward, particularly when conceptualising intervention effects as contingent upon contextual interactions in complex systems" [68]. Aarons et al argued that, with all types of scale-out, an intervention must: (i) retain its core elements; (ii) retain the underlying mechanism of action linking these core elements to health outcomes and (iii) have "sufficient organizational or system support to deliver the intervention as intended to sufficient numbers of the target population" [14] (p. 4).…”