Development of a framework and coding system for modifications and adaptations of evidence-based interventions

Bibliographic Data

ID23331609
AuthorsShannon Wiltsey Stirman (0000-0001-9917-5078, National Center for PTSD, corresponding author), Christopher J Miller (0000-0002-0632-1484, VA Boston Healthcare System), Katherine Toder (University of Pennsylvania), Amber Calloway (University of Massachusetts Boston)
Year2013
Volume8
Issue1
Pages65-65
Publication date2013-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueImplementation Science (JOURNAL)
Journal identifiersISSN: 1748-5908 • E-ISSN: 1748-5908
PublisherSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1186/1748-5908-8-65
PMID23758995
PMCIDPMC3686699
OpenAlexW2109880945
LanguageEN
Citations received101
References cited44

BACKGROUND: Evidence-based interventions are frequently modified or adapted during the implementation process. Changes may be made to protocols to meet the needs of the target population or address differences between the context in which the intervention was originally designed and the one into which it is implemented [Addict Behav 2011, 36(6):630-635]. However, whether modification compromises or enhances the desired benefits of the intervention is not well understood. A challenge to understanding the impact of specific types of modifications is a lack of attention to characterizing the different types of changes that may occur. A system for classifying the types of modifications that are made when interventions and programs are implemented can facilitate efforts to understand the nature of modifications that are made in particular contexts as well as the impact of these modifications on outcomes of interest. METHODS: We developed a system for classifying modifications made to interventions and programs across a variety of fields and settings. We then coded 258 modifications identified in 32 published articles that described interventions implemented in routine care or community settings. RESULTS: We identified modifications made to the content of interventions, as well as to the context in which interventions are delivered. We identified 12 different types of content modifications, and our coding scheme also included ratings for the level at which these modifications were made (ranging from the individual patient level up to a hospital network or community). We identified five types of contextual modifications (changes to the format, setting, or patient population that do not in and of themselves alter the actual content of the intervention). We also developed codes to indicate who made the modifications and identified a smaller subset of modifications made to the ways that training or evaluations occur when evidence-based interventions are implemented. Rater agreement analyses indicated that the coding scheme can be used to reliably classify modifications described in research articles without overly burdensome training. CONCLUSIONS: This coding system can complement research on fidelity and may advance research with the goal of understanding the impact of modifications made when evidence-based interventions are implemented. Such findings can further inform efforts to implement such interventions while preserving desired levels of program or intervention effectiveness.

Coding (social sciences) · Context (archaeology) · Environmental health · Health administration · Health services research · Intervention (counseling) · Population · Psychological intervention · Public health · Variety (cybernetics) · Artificial Intelligence · Computer Science · Health Informatics · Health Policy Implementation Science · Health Sciences Research and Education · Medicine · Meta-analysis and systematic reviews · Nursing