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Using the Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies
Rose Hennessy Garza1, Nora Jacobson2, Andrew Cohen3
1Joseph J Zilber College of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
Implementation Research and Practice
|January 9, 2026
Summary
The Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies (FRAME-IS) is a practical tool for documenting changes in implementation strategies. This study assessed its utility in a multisite trial, finding it useful but with areas for improvement.
Area of Science:
- Implementation Science
- Health Services Research
- Clinical Practice Guidelines
Background:
- Evidence-based practice implementation often requires modifications, necessitating systematic documentation.
- The Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies (FRAME-IS) provides a structured approach to documenting these changes.
- Assessing the utility of FRAME-IS in real-world settings, like multisite trials, is crucial for its refinement and adoption.
Purpose of the Study:
- To evaluate the practical utility and user-friendliness of the FRAME-IS tool.
- To document modifications made to four implementation strategies within the Deidentified Opioid Initiative trial.
- To identify strengths, limitations, and areas for improvement in the application of FRAME-IS.
Main Methods:
- The FRAME-IS was used by an interdisciplinary team to document modifications to four systems consultation strategies.
- Modifications were necessitated by factors including COVID-19, telemedicine, and evolving opioid prescribing guidelines.
- The Deidentified Opioid Initiative trial involved 32 clinics across two healthcare systems using a sequential, multiple-assignment randomized trial design.
Main Results:
- The FRAME-IS was found to be practical, comprehensive, and user-friendly for documenting implementation strategy modifications.
- The tool effectively facilitated reflection on implementation processes and highlighted key research questions.
- Challenges included managing role blurring, capturing cascading modifications, and adapting reporting for multisite clustered trials.
Conclusions:
- The FRAME-IS is a valuable tool for systematically measuring the evolution of implementation strategies.
- Recommendations are provided to enhance the FRAME-IS and guide its application in future research.
- Further research is needed to explore the impact of documented modifications on implementation outcomes.
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