Characterizing provider-led adaptations to mobile phone delivery of the Adolescent Transition Package (ATP) in Kenya using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS): a mixed methods approach

Abstract

Background The COVID-19 pandemic resulted in disruptions to routine HIV services for youth living with HIV (YLH), provoking rapid adaptation to mitigate interruptions in care. The Adolescent Transition to Adult Care for HIV-infected adolescents (ATTACH) study (NCT03574129) was a hybrid I cluster randomized trial testing the effectiveness of a healthcare worker (HCW)-delivered disclosure and transition intervention — the Adolescent Transition Package (ATP). During the pandemic, HCWs leveraged phone delivery of the ATP and were supported to make adaptations. We characterized real-time, provider-driven adaptations made to support phone delivery of the ATP. Methods We conducted continuous quality improvement (CQI) meetings with HCWs involved in phone delivery of the ATP at 10 intervention sites. CQI meetings used plan-do-study-act (PDSA) cycles and were audio-recorded. Adaptations were coded by two-independent coders using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). Adaptation testing outcomes (adopt, retest, or abandon) and provider experience implementing the adaptations were also recorded. We summarized adaptation characteristics, provider experience, and outcomes. Results We identified 72 adaptations, 32 were unique. Overall, adaptations included modification to context (53%, n = 38), content (49%, n = 35), and evaluation processes (13%, n = 9). Context adaptations primarily featured changes to personnel, format, and setting, while content and evaluation adaptations were frequently achieved by simple additions, repetition, and tailoring/refining of the phone delivery strategy. Nine adaptations involved abandoning, then returning to phone delivery. HCWs sought to increase reach, improve fidelity, and intervention fit within their context. Most adaptations (96%, n = 69) were perceived to increase the feasibility of phone delivery when compared to before the changes were introduced, and HCWs felt 83% (n = 60) of adaptations made phone delivery easier. Most adaptations were either incorporated into routine workflows (47%) or tested again (47%). Conclusion Adaptation of phone delivery was a feasible and effective way of addressing challenges with continuity of care for YLH during the COVID-19 pandemic. Adaptations were primarily context adaptions. While FRAME-IS was apt for characterizing adaptations, more use cases are needed to explore the range of its utility. Trial registration Trial registered on ClinicalTrial.gov as NCT03574129.

Application of the FRAME-IS to a Multifaceted Implementation Strategy

“…Two previous studies described similar experiences when using the FRAME-IS to document adaptations to multifaceted implementation strategies supporting integration of practice-based interventions. ( 13 , 14 ) For example, Mangale et al( 13 ) found that adaptations to the implementation strategies were not mutually exclusive and fit within several categories resulting in ‘unavoidable overlap.’ Haley et al ( 9 ) also described challenges to tracking adaptations to a multifaceted implementation strategy using existing frameworks. Like our approach, the authors addressed these challenges by adding more detailed information on the changes using the ERIC taxonomy and developed new codes to augment the broad categorization of strategies offered by current frameworks.…”

“…A small but growing number of studies have utilized the FRAME-IS to provide important information on the adaptability of various implementation strategies in diverse settings including FQHCs. ( 6 , 13 – 16 ) However, most of these studies are limited by their focus on a discrete implementation strategy (e.g., training), which do not reflect the complexity of multifaceted strategies such as practice facilitation (PF). To address this limitation, we leverage our ongoing trial, which is evaluating the effectiveness of PF on implementation fidelity of an evidence-based technology facilitated team care model within a large FQHC, to conduct an ancillary study that characterizes adaptations to our implementation strategy using the FRAME-IS.…”