Guidance For Adapting Evidence-Informed Population Health Interventions For New Contexts: The Adapt Study

Background Adaptation of evidence-informed population health interventions for new contexts may be more efficient than de-novo intervention development, where well developed and tested interventions exist. There is however currently no consensus-based guidance for decision-making on adapting interventions for implementation and/or deciding on the need for re-evaluation in new contexts. We are developing guidance, with funding from MRC-NIHR. This presentation will describe the underpinning research used to develop this guidance, and draft content of the guidance, which will be completed by the end of 2020. Methods We used a phased approach to develop guidance. This began with a systematic review of existing guidance, including papers published between January 2000 and October 2018 identified through searches of 7 databases. This was followed by a scoping review focused on a purposive sample of cases of intervention adaptation identified through this search. Semi-structured qualitative interviews with researchers (N=23), practitioners (N=3), journal editors (N=5) and funders (N=6), were conducted, and analysed using framework analysis. Finally, a three round modified Delphi consensus process was undertaken (N=66). Results The systematic review identified and synthesised 35 sources of guidance to develop a draft framework, which was refined in subsequent phases. Reviews and qualitative interviews identified several ongoing debates in adapting interventions for new contexts, and areas of consensus. Informed by the review, we defined adaptation as ‘intentional modification(s) of an evidence-informed intervention, in order to achieve better fit between an intervention and a new context’. Consensus processes suggested this definition was useful, but emphasised the importance of including guidance for both pro-active and re-active adaptation. Different conceptualisations of fidelity were identified within the reviews and interviews which shaped approaches to adapting interventions. Further, while we initially defined ‘evidence-informed’ interventions as those with prior evidence of effects, qualitative interviews and DELPHI processes suggested a wider framing of ‘evidence-informed’, with interventions often adapted from elsewhere based on evidence of feasibility, but with no prior robust evaluation of effects. Draft recommendations for adapting interventions for new contexts include considerations in relation to what interventions to select, when and how to adapt these, the level of re-evaluation required in the new context, and reporting of adaptation processes and outcomes. Discussion Producers and users of population health evidence face significant uncertainties over whether and how to adapt and re-evaluate interventions in new contexts. This guidance should improve the commissioning, conduct and reporting of studies involving intervention adaptation for new contexts.