Let’s talk about adaptation! How individuals discuss adaptation during evidence-based practice implementation

Abstract

Purpose Researchers suggest that adaptation should be a planned process, with practitioners actively consulting with program developers or academic partners, but few studies have examined how adaptation unfolds during evidence-based practice (EBP) implementation. The purpose of this paper is to describe real-world adaptation discussions and the conditions under which they occurred during the implementation of a new practice across multiple county child welfare systems. Design/methodology/approach This study qualitatively examines 127 meeting notes to understand how implementers and researchers talk about adaptation during the implementation of SafeCare, an EBP aimed at reducing child maltreatment and neglect. Findings Several types of adaptation discussions emerged. First, because it appeared difficult to get staff to talk about adaptation in group settings, meeting participants discussed factors that hindered adaptation conversations. Next, they discussed types of adaptations that they made or would like to make. Finally, they discussed adaptation as a normal part of SafeCare implementation. Research limitations/implications Limitations include data collection by a single research team member and focus on a particular EBP. However, this study provides new insight into how stakeholders naturally discuss adaptation needs, ideas and concerns. Practical implications Understanding adaptation discussions can help managers engage frontline staff who are using newly implemented EBPs, identify adaptation needs and solutions, and proactively support individuals who are balancing adaptation and fidelity during implementation. Originality/value This study’s unique data captured in vivo interactions that occurred at various time points during the implementation of an EBP rather than drawing upon data collected from more scripted and cross-sectional formats. Multiple child welfare and implementation stakeholders and types of interactions were examined.

Adaptations and modifications to a co-designed intervention and its clinical implementation: a qualitative study in Denmark

“…Our findings showed that implementation champions and managers made both planned adaptations and haphazard modifications to better fit the content and context. This finding is in line with previous studies, which have reported both adaptations and modifications to EBIs [ 8 , 9 , 64 – 66 ].…”

“…Adaptations to EBIs challenge the basic assumption that the core components of an intervention must be implemented with fidelity to achieve its intended effectiveness and expected outcomes [ 8 – 10 ]. Much of the fidelity versus adaptation debate has been theoretical [ 1 ], but Durlak [ 11 ] has estimated that as much as 80% of an EBI’s prescribed activities may be omitted during implementation.…”

“…This recognition has led to the development of a number of frameworks and taxonomies that aim to structure and describe the characteristics of adaptations and modifications [ 1 , 9 , 17 , 19 – 22 ]. Despite these efforts, it remains difficult to fully capture the complexity of adaptation and modification processes, and empirical studies are needed to deepen our understanding of the change processes that interventions undergo when implemented in routine clinical practice [ 2 , 8 ].…”

“…The co-design literature does not use the concepts of fidelity, adaptation and modifications, but it can be assumed that co-design approaches facilitate a high degree of fidelity and require less adaptations and modifications compared with interventions that are not co-designed with stakeholders. However, there is a knowledge gap on the relationship between co-design and adaptations, if we look at empirical studies in which many focus on co-design [ 30 , 37 – 40 ] while others focus on adaptations [ 6 , 8 , 9 , 14 ]. The question is not whether adaptations are made, but whether co-designed interventions prevent modifications, understood as reactive changes implemented somewhat haphazardly for convenience or to save time, and how these modifications influence the clinical and implementation outcomes.…”