Adapting evidence-informed population health interventions for new contexts: a scoping review of current practice

Abstract

Background Implementing evidence-informed population health interventions in new contexts often requires adaptations. While the need to adapt interventions to better fit new contexts is recognised, uncertainties remain regarding why and when to adapt (or not), and how to assess the benefits (or not) of adaptation. The ADAPT Study aims to develop comprehensive guidance on adaptation. This scoping review informs guidance development by mapping and exploring how adaptation has been undertaken in practice, in public health and health services research. Methods We searched seven databases from January 2000 and October 2018 to identify eligible studies for this scoping review and a related systematic review of adaptation guidance. We mapped the studies of adaptation by coding data from all eligible studies describing the methods, contexts, and interventions considered for adaptation. From this map, we selected a sample of studies for in-depth examination. Two reviewers extracted data independently into seven categories: description, key concepts, types, rationale, processes, evaluation methods, evaluation justification, and accounts of failures and successes. Results We retrieved 6694 unique records. From 429 records screened at full text, we identified 298 eligible studies for mapping and selected 28 studies for in-depth examination. The majority of studies in our map focused on micro- (i.e., individual-) level interventions (84%), related to transferring an intervention to a new population group within the same country (62%) and did not report using guidance (73%). Studies covered a range of topic areas, including health behaviour (24%), mental health (19%), sexual health (16%), and parenting and family-centred interventions (15%). Our in-depth analysis showed that adaptation is seen to save costs and time relative to developing a new intervention, and to enhance contextual relevance and cultural compatibility. It commonly follows a structured process and involves stakeholders to help with decisions on what to adapt, when, and how. Conclusions Adaptation has been undertaken on a range of health topics and largely in line with existing guidance. Significant gaps relate to adaptation of macro- (e.g., national-) level interventions, consideration of programme theories, mechanisms and contexts (i.e., a functional view of interventions), nuances around stakeholder involvement, and evaluation of the adapted interventions. Registration Open Science Framework, 2019, osf.io/udzma.

Integrated knowledge translation to advance noncommunicable disease policy and practice in South Africa: application of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework

“…The paper is therefore limited to presentation of our own views and perspectives. However, the importance of stakeholder perspectives has been planned [ 38 ] and will be reported in a future publication that seeks to evaluate the CEBHA+ IKT approach across all African partner sites. We envisage that our perspective complements the broader evaluation, as it provides more in-depth contextualized information to help interpret the CEBHA+ IKT process and outcome results.…”

“…The CEBHA+ coordinated IKT approach was envisioned as a six-step process [ 38 ] (Fig. 1 ) that commenced with a foundational workshop for all CEBHA+ partners.…”

“…The entire process, however, was iterative in nature and supported by a working group with IKT methods expertise, training opportunities. Step 6—a semi-external cross-country evaluation of the CEBHA+ IKT approach—will be implemented by one of the German partners, the Ludwig Maximilian University of Munich (LMU), which is not directly involved in operationalizing country-specific IKT approaches [ 38 ].

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The what, why and when of adapting interventions for new contexts: A qualitative study of researchers, funders, journal editors and practitioners’ understandings

“…It aims to support researchers, policy-makers, practitioners, funders and journal editors in the funding, conduct and reporting of research on adaptation. The study comprised three work packages: 1) A systematic review of existing adaptation guidance and scoping review of case examples of intervention adaptation [ 2 , 25 ]; 2) A qualitive study using semi-structured interviews to explore the understandings, perspectives and experiences of researchers, funders, journal editors, and policy and practice stakeholders; and 3) A Delphi expertise consensus exercise to scope the clarity of the definitions and constructs used in the guidance, explore and capture key debates, identify agreement on important adaptation processes, and ascertain areas where there is limited consensus [ 26 ].…”

“…The work-packages were inter-related. The systematic review [ 2 ], scoping review [ 25 ] and qualitative study data analysis provided items and issues that required consideration in the Delphi consensus exercise [ 26 ]. In particular, the qualitive data analysis informed the concepts that were identified as central to the guidance and definitions that required consultation, both in terms of clarity and usefulness.…”