Adaptations and modifications to a co-designed intervention and its clinical implementation: a qualitative study in...

Area of Science:

• Implementation Science
• Healthcare Intervention Design
• Patient Mobility Enhancement

Background:

• Debate exists on adapting evidence-based interventions (EBIs) in healthcare.
• Low fidelity occurs when interventions deviate from their original design.
• The WALK-Cph project used co-design to enhance intervention fidelity for older medical patients' mobility.

Purpose of the Study:

• To describe and analyze adaptations and modifications to the co-designed WALK-Cph intervention.
• To evaluate the impact of co-design on intervention fidelity and implementation.

Main Methods:

• Qualitative ethnographic field study.
• Participant observations, workshops, and semi-structured interviews.
• Data analyzed using the Framework Method and Adaptation-Impact Framework.

Main Results:

• 44 adaptations and modifications were made to the WALK-Cph intervention and implementation plan.
• 21 adaptations were planned, while 23 modifications occurred haphazardly.
• Adaptations and modifications had mixed results on enhancing fidelity; modifications were ongoing and context-dependent.

Conclusions:

• Despite extensive co-design, numerous adaptations and modifications persisted.
• Co-design may have had a limited effect on controlling changes.
• Adaptations are ongoing, situationally and contextually shaped, challenging planned intervention control.