Construct Details

ConstructAdaptation and evolution
DefinitionFor the success of D&I, interventions often need to be adapted to fit the local context (i.e., needs and realities). Adaptation is defined as the degree to which an evidence-based intervention is changed or modified by a user during adoption and implementation to suit the needs of the setting or to improve the fit to local conditions. The need for adaptation and understanding of context has been called Type 3 evidence (i.e., the information needed to adapt and implement an evidence-based intervention in a particular setting or population). Ideally, adaptation will lead to at least equal intervention effects as is shown in the original efficacy or effectiveness trial. To reconcile the tension between fidelity and adaptation, the core components (or essential features) of an intervention (i.e., those responsible for its efficacy/effectiveness) must be identified and preserved during the adaptation process.
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Adaptable protocols and procedures


Adaption or reformulation


By whom was the decision to modify made?

Consider need for appropriate, reasoned variation

Content modifications

Contextual modifications

Design Intervention Prototype – (4A) design intervention to incorporate scientific evidence and locally developed programs

Design Intervention Prototype – (4B) design intervention for fit to community setting and population

Design Intervention Prototype – Integrate 4A and B to develop intervention components; vet prototype for relevance and potential for success.

Determine predictors of adherence/non-adherence

Engagement and Adaptation


Evolution of intervention

Improved Pre-adoption

Improved Adoption

Levels at which content modifications occur

Maintenance and Evolution

Modifications to training and evaluation processes

Ongoing change

Phase 0: identification of potential areas of low-value healthcare

ModelsStetler Model of Research Utilization

Community Based Participatory Research (CBPR)

Technology Transfer Model

Conceptual Framework for Research Knowledge Transfer and Utilization

Marketing and Distribution System for Public Heatlh

Knowledge Exchange Framework

Health Promotion Technology Transfer Process

Interacting Elements of Integrating Science, Policy, and Practice

Pathways to Evidence Informed Policy

CDC DHAP's Research-to-Practice Framework

Practical, Robust Implementation and Sustainability Model (PRISM)

Consolidated Framework for Implementation Research

Replicating Effective Programs Framework

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

General theory of implementation

Dynamic Sustainability Framework

Intervention Mapping

Framework for Enhancing the Value of Research for Dissemination and Implementation

Adaptation in dissemination and implementation science

EQ-DI Framework

Adherence Optimization Framework

RE-AIM 2.0/Contextually Expanded RE-AIM

Model for Predictors of Adoption

Transcreation Framework for Community-engaged Behavioral Interventions to Reduce Health Disparities

Dissemination and Implementation Framework for an Early Childhood Obesity Prevention Program

Choosing Wisely Deimplementation Framework

Number of Models26
MeasureGEM D&I link: Adaptation and Evolution