When and how do ‘effective’ interventions need to be adapted and/or re-evaluated in new contexts? The need for guidance

Evans, Rhiannon Emily; Craig, Peter; Hoddinott, Pat; Littlecott, Hannah; Moore, Laurence; Murphy, Simon; O’Cathain, Alicia; Pfadenhauer, Lisa M.; Rehfuess, Eva; Segrott, Jeremy; Moore, Graham

doi:10.1136/jech-2018-210840

Cited by 73 publications

(74 citation statements)

References 12 publications

(12 reference statements)

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“…There is currently no guidance on how to adapt evidence-based interventions for new contexts [45], but we know that the ability to mutually adapt top-down effective principles and bottom-up changes "is a special niche and it's not easy to do" [16] (p. 179). It takes skills, perseverance, and time.…”

Section: Discussionmentioning

confidence: 99%

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

Verjans-Janssen

Gerards

Verhees

et al. 2020

IJERPH

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School health promotion is advocated. Implementation studies on school health promotion are less often conducted as effectiveness studies and are mainly conducted conventionally by assessing fidelity of “one size fits all” interventions. However, interventions that allow for local adaptation are more appropriate and require a different evaluation approach. We evaluated a mutual adaptation physical activity and nutrition intervention implemented in eight primary schools located in low socioeconomic neighborhoods in the Netherlands, namely the KEIGAAF intervention. A qualitative, multiple-case study design was used to evaluate implementation and contextual factors affecting implementation. We used several qualitative data collection tools and applied inductive content analysis for coding the transcribed data. Codes were linked to the domains of the Consolidated Framework for Implementation Research. NVivo was used to support data analysis. The implementation process varied greatly across schools. This was due to the high level of bottom-up design of the intervention and differing contextual factors influencing implementation, such as differing starting situations. The mutual adaptation between top-down and bottom-up influences was a key element of the intervention. Feedback loops and the health promotion advisors played a crucial role by navigating between top-down and bottom-up. Implementing a mutual adaptation intervention is time-consuming but feasible.

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Section: Discussionmentioning

confidence: 99%

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

Verjans-Janssen

Gerards

Verhees

et al. 2020

IJERPH

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“…There is also the added benefit of such programs requiring very little or no ongoing investment in infrastructure and resources, making it credible for large-scale dissemination and adoption [ 33 ]. While these findings suggest that more could be done to improve the fidelity of MK’s implementation, the appropriateness of 100% fidelity has been called into question [ 34 , 35 ]. Durlak (2015) [ 34 ] contended that there may be a minimum threshold for implementation fidelity at which desired program outcomes are obtained.…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of the Implementation of a UK School-Based Running Program

et al. 2020

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The adoption of school-based running programs has rapidly increased over the last five years in the UK and globally. However, there is currently a lack of information on how these initiatives are implemented, and whether they are generalizable and/or sustainable. This study evaluated the implementation (including reach, fidelity, and dose) of a school-based running program over seven months to inform future delivery. This observational study used a mixed-method, single-group, before-and-after design strengthened by multiple interim measurements to evaluate the implementation of an optional school-based running program. Five state-funded primary schools in Leicestershire, UK, participated, with 17 teachers and 189 (81 boys (47.4%) and 90 girls (52.6%)) Year 5 pupils (aged 9–10 years) from eight classes. During the 2016/2017 academic year, data were collected via several measures (including interviews, focus groups, observations, questionnaires, and teacher implementation logs) at multiple levels (i.e., school and individual) and at multiple time points during implementation. Follow up qualitative data were also collected during 2017/2018. The school-based running program achieved good reach, with 100% of pupils opting to participate at some point during the academic year. All schools implemented the program with good fidelity, although the level of implementation varied between schools and over time. The average number of sessions held per week ranged from 0.94–3.89 with the average distance accumulated per pupil per week ranging from 0.02 to 2.91 kilometers and boys being more likely than girls to be classed as high-level participators. Despite an initial drop off in participation over time, all schools remained engaged in the program and continued to implement it until the end of the school year. Contextual features (e.g., staff capacity and resources) differed between schools and influenced the quality of implementation and the frequency of delivery. The school-based running program is simple, inexpensive, and versatile and can be implemented by schools with relative ease. However, schools are diverse settings, with unique challenges to ongoing delivery. Thus, planned adaptations, specific to each school’s context, are likely necessary to sustain participation in the longer term and should be considered prior to implementation.

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“…There is also the added bene t of such programmes requiring very little or no ongoing investment in infrastructure and resources, making it credible for large scale dissemination and adoption (34). Whilst these ndings suggest that more could be done to improve the delity of MK's implementation, the appropriateness of 100% delity, has been called into question (35,36). Durlak (2015) (35) contend that there may be a minimum threshold for implementation delity at which desired programme outcomes are obtained.…”

Section: Fidelitymentioning

confidence: 99%

An evaluation of the implementation of a UK school-based running programme

Chalkley

Routen

Harris

et al. 2020

Preprint

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Background The adoption of school-based running programmes has rapidly increased in recent years. However, there is a lack of information on how these initiatives are implemented, and how generalisable and sustainable they are. This study evaluated the implementation of a school-based running programme, Marathon Kids (MK), over 7 months. The aim was to understand the context within which MK was implemented in each of the schools and the key elements of implementation including reach, fidelity and dose. Methods This study used a mixed method, single group before-and-after design strengthened by multiple interim measurements. Five state-funded primary schools in Leicestershire, UK participated, with 17 teachers and 189 (81 boys (47.4%) and 90 girls (52.6%)) Year 5 pupils (aged 9–10 years) from eight classes. During the 2016/2017 academic year, data were collected via measures at multiple levels (i.e. school and individual) and at multiple time points during implementation. Follow up qualitative data were also collected during 2017/2018. Results Marathon Kids achieved good reach, with all pupils opting to participate at some point during the academic year. All schools implemented MK with good fidelity, although the level of implementation varied between schools and over time. The average number of MK sessions held per week ranged from 0.94–3.89 with the average distance accumulated per pupil per week ranging from 0.02 to 2.91 kilometres and boys being more likely than girls to be classed as high-level participators. Despite an initial drop off in participation over time, all schools remained engaged in the programme and continued to implement MK until the end of the school year. Contextual features (e.g., staff capacity and resources) differed between schools and influenced the quality of implementation of MK and the frequency of delivery. Conclusions Marathon Kids is a simple, inexpensive and versatile physical activity programme which can be implemented by schools with relative at ease. However, schools are diverse settings, with unique challenges to ongoing delivery. Thus, planned adaptations, specific to each school’s context, is likely necessary to sustain participation in the longer term.

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When and how do ‘effective’ interventions need to be adapted and/or re-evaluated in new contexts? The need for guidance

Cited by 73 publications

References 12 publications

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

An Evaluation of the Implementation of a UK School-Based Running Program

An evaluation of the implementation of a UK school-based running programme

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