Start cooperation with the parties that will test the adapted intervention

Successful adaptation requires potentially repeated testing of the intervention and diverse data collection. With this in mind, it is advisable to start cooperation as early as possible.

Evaluate the description and mechanisms of change of the intervention that will be adapted

The adaptation of an intervention requires that the intervention developer has carefully described the intervention, its execution and mechanism of change including the core components. If the intervention has not been adequately described, its replication and evaluation is nearly impossible. Such an intervention should not be adapted.

Establish an adaptation team

It is advisable to establish a multidisciplinary team for the planning and conducting the adaptation to ensure that the views of different parties are taken into account. Before putting together the adaptation team, it is advisable to agree who is responsible for the coordination of the adaptation. When necessary, the team should utilise the views of specialists in different fields such as researchers, professionals trained in the intervention,
representatives of the organisation that will use or test the adapted intervention, representatives of clients, the developers of the intervention and the intermediary
organisation.

Assess the context-fit of the intervention

It is important to assess what differences and similarities there are between the intervention’s new context and the contexts from which the evidence of its effectiveness
has been accumulated. This helps to determine whether the intervention can be adapted and transferred to the new context, or whether the differences between the contexts are too large.

It is also advisable to find out how the intervention has been adapted elsewhere, if at all, and to take advantage of their experiences.

The intervention’s fit with the new context can be assessed with the help of a checklist, for example. The ASTAIRE tool helps to analyse the transferability of health promotion interventions.

Plan the modifications

In planning the modifications , the adaptation team can utilise the FRAME framework and use it to evaluate the following aspects:

• modification needs related to the content of the intervention
• modification needs arising from the context
• modification needs related to the intervention manual and other materials, if any
• modification needs related to training and guidance on the use of the intervention.

If the intervention is entirely new (to Finland), the specification of adaptation needs should be guided by the observations made regarding the differences between contexts in stage four (preparing for adaptation).

If the intervention is already in use, the intermediary organisation may have information regarding the usability of the intervention and its potential modification needs. This information may come from intervention supervisors or from supplementary training, for example.

Itla has developed the Viisio tool for the systematic and comprehensive assessment of intervention modification needs. Ask us more about the tool!

Ensure that the core components and mechanisms of change are preserved

Evaluate the modifications and ensure that they do not alter the core components or mechanisms of change that drive the intervention’s effectiveness. Check that the
modifications will not lead to unwanted consequences, such as making the intervention unnecessarily complex.

Implement and document the modifications

The documentation of the modifications is essential, as it makes it possible to evaluate and replicate the adaptations. The FRAME framework can be utilised in the description and evaluation of the modifications. See further information from the articles that describe adaptations to interventions.

Conduct a pilot of the adapted intervention and assess further modification needs

In connection with piloting the adapted intervention, it is important to evaluate its fit with clients, professionals and the new context.

The key objective of piloting is to evaluate the feasibility of the adapted intervention and identify further modification needs. Carrying out multiple rounds of piloting is sometimes necessary. One way to assess modification needs is the Viisio tool developed by Itla. Ask our experts for more information!

Describe the adapted intervention and the adaptation process

High-quality and well-described adaptation supports the effectiveness of the intervention. The FRAME framework can be utilised in describing the adaptation.

To date, only a few comprehensive accounts of the adaptation of psychosocial interventions aimed at children and adolescents have been published in Finland and elsewhere. See examples of adaptation accounts.

It is also important to carefully describe the adapted intervention, for example in the form of a manual or in a scientific publication, so that it can be evaluated and utilised more extensively. The TIDieR checklist provides support for the description of interventions.

Evaluate the effectiveness of the adapted intervention if necessary

The greater the difference between the original context and the new context and the greater the extent of the modifications, the more important it is to carry out a new
effectiveness study. This is a way to ensure that the intervention remains effective in the new context after the adaptation.

Support the organisation that will implement the intervention to ensure high-quality implementation

High-quality and systematic implementation of the intervention increases the likelihood of the intervention becoming well-established and that clients benefit from an effective intervention. Read more about the systematic implementation of interventions.