Frameworks for adaptation of health guidelines: a systematic survey update

Guideline development is both time-consuming and resource-intensive, and duplication of efforts contribute to research waste. Although adopting existing guidelines is an efficient alternative, it often fails to account for contextual factors. Adapting trustworthy, previously developed relevant guidelines offers a promising alternative. Thus, we aimed to identify, describe and evaluate formal frameworks for the adaptation of health-related guidelines.

We updated a previously published systematic survey of guideline adaptation frameworks by searching MEDLINE (Ovid) and Embase (Ovid) from January 1^st, 2015, to October 31^st, 2025. Eligible studies described an adaptation framework for health guidelines in sufficient detail to allow reproducibility. We excluded reviews, guideline adaptations, and implementation reports. We extracted in duplicate and independently data on framework characteristics and presented results in both narrative and tabular formats.

Our search identified 20 guideline adaptation frameworks, up from eight identified in the previous survey. These frameworks included five to 24 steps (median: 13). Each framework followed one of four primary approaches: ADAPTE-based (6/20); GRADE-ADOLOPMENT-based (3/20); hybrid approaches (2/20); and other approaches (9/20). ADAPTE-based frameworks follow a comprehensive three-phase, 24-step process to assess and modify entire source guidelines. In contrast, GRADE-ADOLOPMENT-based frameworks focus on recommendation-level contextualization using evidence-to-decision frameworks. The remaining frameworks utilized other methods for their jurisdiction, or organization-specific contexts. The most frequently reported challenges were high resource and expertise requirements, dependence on the quality and availability of source guidelines, contextual and implementation barriers, and limited capacity for new evidence synthesis.

Guideline adaptation frameworks vary substantially in scope and methods, reflecting a balance between methodological rigor and feasibility. ADAPTE- and GRADE- ADOLOPMENT-based approaches provide structured methods, while more recent frameworks prioritize flexibility. This synthesis will help guideline developers select approaches that best fit their context and resources.