The Frame: An Expanded Framework for Reporting Adaptations and Modifications

Background: Adaptation, defined as a process of thoughtful and deliberate alteration to the design or delivery of an intervention with the goal of improving its fit or effectiveness in a given context, nearly always occurs during implementation. Additionally, adaptation has been described as a process associated with successful implementation or sustainability, suggesting its potential as an implementation mechanism. Promoting adaptability has been identified as an implementation strategy; however, adaptation has rarely been experimentally tested as a strategy. Despite considerable recent interest in the implementation science field, the process, nature, and outcomes of adaptation have often not been well documented and, consequently, not evaluated and understood. Without better understanding the forms of adaptation that promote successful implementation, systematic evaluation of adaptation as a strategy may be hindered.

Method: To address this gap in the literature, we describe the Framework for Reporting Adaptations and Modifications-Expanded (FRAME). Based on Stirman, Miller, Castro & Calloway’s (2013), the FRAME has been expanded to map onto recommendations for documenting and reporting adaptations: When in the implementation process the change was made, Whether the change was planned or unplanned, proactive or reactive, Who determined that the change should be made, What is modified, At what level of delivery the change is made, Type or nature of context or content-level changes, The extent to which the change is fidelity-consistent. Furthermore, we recommend specifying, The rationale, or reasons, for the changes made.

Findings: We discuss applications of the framework for the purposes of reporting on and describing the process of modification or adaptation. We also address the reasons for adaptation by highlighting contextual factors that may play a role in how and why interventions are adapted or modified. Additionally, we describe expansion of the framework to consider timing of adaptation or modification. We next consider documentation and reporting of modifications and adaptations. Finally, we present a research agenda to advance what is known about the impact of adaptation on intervention effectiveness, implementation, and sustainability.

Conclusions: Much work remains to be done to develop generalized knowledge about the process, nature, and outcomes of modifications made to different types of interventions, in vastly different contexts. The FRAME is intended to capture information that reflects the complex and dynamic settings in which implementation occurs. It is important to approach the study of adaptation in conjunction with efforts to understand the context and perspectives of the multiple stakeholders that participate in efforts to implement and spread effective interventions.