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Related Experiment Video

Updated: Dec 14, 2025

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Multi-method process maps: An interdisciplinary approach to investigate ad hoc modifications in protocol-driven

Thomas I Mackie1,2, Leah Ramella3, Ana J Schaefer1

  • 1Rutgers School of Public Health, Piscataway, NJ, USA.

Journal of Clinical and Translational Science
|July 23, 2020
PubMed
Summary

Implementation scientists can now systematically study dynamic, ad hoc modifications in interventions. This research uses process maps and interviews to understand how these changes impact outcomes, like autism spectrum disorder diagnosis times.

Keywords:
Implementation scienceadaptationmodificationprocess assessment

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Area of Science:

  • Implementation Science
  • Systems Science
  • Social Science

Background:

  • Dynamic implementation processes often involve ad hoc modifications, challenging intervention fidelity.
  • Limited understanding of ad hoc modifications hinders evidence-based hypotheses on intervention effectiveness and cost.
  • A systematic approach is needed to characterize ad hoc modifications and their impact on outcomes.

Purpose of the Study:

  • To propose and illustrate a multi-method process map methodology for systematically collecting data on ad hoc modifications.
  • To characterize ad hoc modifications in protocol-driven interventions and their potential impact on primary outcomes.

Main Methods:

  • Employed process maps (systems science) and focus groups/interviews (social science).
  • Focus groups with developers characterized the protocol 'as envisioned'.
  • Interviews with frontline administrators characterized the process 'as realized in practice'.

Main Results:

  • Frontline administrators reported ad hoc modifications influencing primary outcomes, such as time to autism spectrum disorder (ASD) diagnosis.
  • Modifications were made to accommodate provider/parent concern about ASD, parental readiness, and family service needs.
  • Process maps identified when modifications occurred within a multistage screening protocol for ASD.

Conclusions:

  • Investigating ad hoc modifications offers opportunities for developing empirically based adaptive interventions.
  • Routine reporting standards are crucial for transparency in studying ad hoc modifications.
  • This methodology aids in understanding how real-world adaptations affect intervention outcomes.