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

Area of Science:

• Implementation Science
• Health Services Research
• Program Evaluation

Background:

• Evidence-based interventions (EBIs) are often modified during implementation to suit specific populations or contexts.
• The impact of these modifications on intervention benefits remains unclear.
• Characterizing modification types is crucial for understanding their effects.

Purpose of the Study:

• To develop and validate a system for classifying modifications made to EBIs.
• To facilitate research on the nature and impact of intervention changes.

Main Methods:

• A classification system for intervention modifications was developed.
• 258 modifications from 32 published articles were coded.
• The system included categories for content and contextual modifications, modification level, and modifiability.

Main Results:

• Identified 12 types of content modifications and 5 types of contextual modifications.
• Modification levels ranged from individual patient to community.
• Coding scheme demonstrated reliable classification with minimal training.

Conclusions:

• The developed coding system can enhance research on intervention fidelity and modification impact.
• This can inform implementation strategies to maintain or improve intervention effectiveness.