Adaptation in Dissemination and Implementation Science

Despite advances in research methods in the field of dissemination and implementation (D&I), we have not yet been able to answer the decades-old question of what works best for whom under what circumstances. Investigators are still calling for increased action in promoting evidence-based interventions in usual care and for testing interventions and designs to optimize outcomes. In light of the diversity of patient populations, providers, and service settings into which interventions are delivered, it is unlikely that the same program, techniques and strategies can be implemented successfully in the exact same way across multiple contexts, particularly if programs are being transposed from rich contexts to low-middle income countries. Scholars from the fields of implementation science and cultural adaptation warn of the dangers of implementing evidence-based interventions without attending to the fit of the interventions to the context. If we are to optimize interventions aiming to enhance child and youth positive outcomes in different settings, attention needs to be given to the tension between scientific rigor and adaptation to the context. Drawing from the cultural adaptation field and recent advances in D&I science, we propose that scholars should consider evaluating, documenting, and rigorously studying the adaptation process and outcomes. This is a conceptual presentation aiming to (a) outline why D&I science scholars should consider adaptation, (b) describe when to adapt intervention, followed by outlining components that scholars should consider adapting, how to adapt components, how to evaluate the impact of adaptation, and (c) provide our recommendations for the D&I science field regarding adaptation of interventions in the space of prevention science for child and youth. Careful consideration of how to consider the adaptation process during the implementation of evidence-based interventions allows for prevention researchers to balance scientific rigor with social justice, in particular when working in low-resource settings.