The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare

Abstract

Background Implementation strategies are necessary to ensure that evidence-based practices are successfully incorporated into routine clinical practice. Such strategies, however, are frequently modified to fit local populations, settings, and contexts. While such modifications can be crucial to implementation success, the literature on documenting and evaluating them is virtually nonexistent. In this paper, we therefore describe the development of a new framework for documenting modifications to implementation strategies. Discussion We employed a multifaceted approach to developing the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS), incorporating multiple stakeholder perspectives. Development steps included presentations of initial versions of the FRAME-IS to solicit structured feedback from individual implementation scientists (“think-aloud” exercises) and larger, international groups of researchers. The FRAME-IS includes core and supplementary modules to document modifications to implementation strategies: what is modified, the nature of the modification (including the relationship to core elements or functions), the primary goal and rationale for the modification, timing of the modification, participants in the modification decision-making process, and how widespread the modification is. We provide an example of application of the FRAME-IS to an implementation project and provide guidance on how it may be used in future work. Conclusion Increasing attention is being given to modifications to evidence-based practices, but little work has investigated modifications to the implementation strategies used to implement such practices. To fill this gap, the FRAME-IS is meant to be a flexible, practical tool for documenting modifications to implementation strategies. Its use may help illuminate the pivotal processes and mechanisms by which implementation strategies exert their effects.

“It’s good to feel like you’re doing something”: a qualitative study examining state health department employees’ views on why ineffective programs continue to be implemented in the USA

“…Often, state and local health departments in the USA are funded to deliver a particular program exactly as it was developed, with little flexibility for adapting programs. Recent efforts to support public health researchers and professionals as they plan for, implement, and track adaptations, such as the IM ADAPT tool ( www.imadapt.org ) and FRAME, have great potential to increase the use, tracking, and assessment of adaptation in public health practice [ 41 , 42 ].…”

Implementation of the Connect for Health pediatric weight management program: study protocol and baseline characteristics

“…As we implement the program, we will closely monitor program uptake and will take a practical approach by modifying our strategies and adapting as necessary. Throughout the implementation phase, we will document modifications to the program and implementation strategies using the framework for Reporting Adaptations and Modifications-Expanded [37,38]. We anticipate modifications to program delivery as three of the four healthcare organizations have shifted to telemedicine for well-child visits due to the COVID-19 pandemic.…”

An implementation intervention to increase the routine provision of antenatal care addressing gestational weight gain: study protocol for a stepped-wedge cluster trial

“… Final refinement of implementation strategies and development of strategy content will be undertaken following consultation with key antenatal care providers and managers from each of the three participating sectors. All modifications made to the gestational weight gain care pathway and implementation intervention due to sector context and needs will be reported according to the FRAME-IS [ 63 ]. …”