Adaptation and evolution

Adaptation and evolution

Number of Models:
The number of models that include elements aligned with the given construct.


Components abstracted from each model and aligned with the given construct.



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 Adoption

Improved Pre-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

The definition of the construct.

For 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.

Related Models

External link to measures on the GEM site for the given construct.

GEM D&I link: Adaptation and Evolution