Adapt

Adaptation of D&I TMFs can be important to make the model fit with the context of your D&I project. Well thought out adaptation often improves the appropriateness of the selected TMF to the intervention being disseminated or implemented, the population, and the setting. Adaptations to D&I TMFs might be necessary to:

• Align the constructs of the D&I TMF with the setting, population, or topic of the D&I project (tailoring the name of a construct to align with the context).
• Provide more specificity in constructs (i.e. providing examples of the construct or identifying sub-constructs more specific to the D&I project).
• Highlight relationships between constructs.
• TMFs should be living documents, or works-in-progress, not static entities.

• It allows researchers to build on previous findings.
• It helps demonstrate generalizability of the TMF thereby enhancing our understanding of how to operationalize a TMF and its constructs.
• Adaptation contributes to the field by testing modifications to existing TMFs, such as disregarding pieces shown to be ineffective or adding constructs that have been found important in a given context.
• It provides an excellent opportunity for TMF testing. This could add innovation to a study.

• Initial identification of a D&I TMF to adapt should consider factors that influence the fit of a TMF such as
  • The intervention and the implementation strategy(ies) (e.g., technology and resources needed for intervention delivery: high-speed Internet connection, media skills).
  • The organization and practitioners/providers delivering the intervention.
  • The target population and/or setting for the intervention/implementation (e.g., sociodemographics, geography, language, culture).
  • If your study addresses health equity.
• Please note: When drastic changes are made to a TMF, it can become a weakness of a proposed D&I project.
• When D&I TMFs are changed, adaptations should be documented and monitored so that the impact of changes on TMF applicability can be reported and incorporated into the literature.

It is difficult to provide detailed guidance on how much/little adaptation is appropriate or how much on an original TMF must be maintained (e.g. How many constructs can I change? What are the core elements of a TMF?). Like the other sections of this tool, there is not a single “cookbook” approach to TMF adaptation, every situation is different and every study is different. It helps to have someone on your team with experience in implementing and using TMFs and to work with your stakeholders who can inform what adaptations are needed for the D&I TMF to be relevant to your context. Along the way, documenting adaptations and the reasons for those adaptations is important.