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Updated: Aug 13, 2025

Visualizing Visual Adaptation
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Getting to implementation: Adaptation of an implementation playbook.

Vera Yakovchenko1, Shari S Rogal1,2,3, David E Goodrich1

  • 1Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States.

Frontiers in Public Health
|January 23, 2023
PubMed
Summary
This summary is machine-generated.

Adapting the "Getting To Outcomes" playbook into "Getting To Implementation" (GTI) improved healthcare strategy selection and use. GTI required modifications for clarity and sustainability, highlighting challenges in pragmatic data collection for implementation science.

Keywords:
adaptationfidelityhepatologyhepatomaimplementation sciencelivermodificationstrategies

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Area of Science:

  • Implementation Science
  • Healthcare Improvement Strategies
  • Program Adaptation

Background:

  • Tailoring implementation strategies is crucial for evidence-based practice translation but remains underdeveloped.
  • The
  • Getting To Outcomes
  • ® (GTO) playbook aids community organizations in planning behavioral health programs.

Purpose of the Study:

  • To adapt the GTO playbook into
  • Getting To Implementation
  • (GTI) for selecting, tailoring, and using implementation strategies in healthcare settings.
  • To support healthcare teams in improving guideline-concordant medical care.

Main Methods:

  • Participatory co-design and adaptation of GTO into GTI using embedded evaluation.
  • Application of the Framework for Reporting Adaptations and Modifications to Evidenced-based Implementation Strategies (FRAME-IS) for documentation.
  • Triangulation of data from interviews, observations, content analysis, and fidelity tracking over 3 years at 12 VA medical centers.

Main Results:

  • Pre-implementation adaptations focused on context and content for acceptability, appropriateness, and feasibility.
  • Post-implementation modifications were reactive, addressing adoption, fidelity, and sustainability.
  • All adaptations were collaborative, maintaining fidelity at the facilitator/implementer level.

Conclusions:

  • GTI facilitated healthcare teams' selection and use of implementation strategies but needed modifications for clarity and progression in key steps.
  • The study underscores challenges in pragmatic data collection and synthesis for implementation, fidelity, and adaptation.
  • Ongoing refinement is necessary for effective implementation strategy adaptation in healthcare.