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Area of Science:

  • Public Health
  • Health Services Research
  • Implementation Science

Background:

  • Complex public health interventions require adaptation in real-world settings, especially during dynamic events like the COVID-19 pandemic.
  • Systematic documentation of intervention adaptations is crucial for evaluating implementation impact.
  • The CO-CREATE project focused on addressing COVID-19 testing disparities in a US/Mexico border community.

Purpose of the Study:

  • To describe the processes for tracking and evaluating adaptations made during the CO-CREATE project.
  • To assess the impact of these adaptations on intervention implementation and outcomes.

Main Methods:

  • A longitudinal, prospective, mixed-methods approach was used to document adaptations across all project phases.
  • Adaptations were recorded weekly in an electronic database, capturing 16 characteristics.
  • The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided the impact assessment of each adaptation.

Main Results:

  • 98 adaptations were identified, with 94.9% being planned.
  • Most adaptations occurred during the mid/late implementation phase.
  • 45.9% of adaptations positively impacted service delivery efficiency, partner engagement, and community reach.

Conclusions:

  • The study details a systematic, prospective approach to documenting and analyzing intervention adaptations over two years.
  • Lessons learned can inform best practices for adapting interventions to ensure sustainable implementation and reduce health disparities.
  • This methodology provides a framework for understanding adaptation's role in public health and clinical programs.