Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA.
Implement Sci. 2013 Jun 10;8:65. doi: 10.1186/1748-5908-8-65.
Evidence-based interventions are frequently modified or adapted during the implementation process. Changes may be made to protocols to meet the needs of the target population or address differences between the context in which the intervention was originally designed and the one into which it is implemented [Addict Behav 2011, 36(6):630-635]. However, whether modification compromises or enhances the desired benefits of the intervention is not well understood. A challenge to understanding the impact of specific types of modifications is a lack of attention to characterizing the different types of changes that may occur. A system for classifying the types of modifications that are made when interventions and programs are implemented can facilitate efforts to understand the nature of modifications that are made in particular contexts as well as the impact of these modifications on outcomes of interest.
We developed a system for classifying modifications made to interventions and programs across a variety of fields and settings. We then coded 258 modifications identified in 32 published articles that described interventions implemented in routine care or community settings.
We identified modifications made to the content of interventions, as well as to the context in which interventions are delivered. We identified 12 different types of content modifications, and our coding scheme also included ratings for the level at which these modifications were made (ranging from the individual patient level up to a hospital network or community). We identified five types of contextual modifications (changes to the format, setting, or patient population that do not in and of themselves alter the actual content of the intervention). We also developed codes to indicate who made the modifications and identified a smaller subset of modifications made to the ways that training or evaluations occur when evidence-based interventions are implemented. Rater agreement analyses indicated that the coding scheme can be used to reliably classify modifications described in research articles without overly burdensome training.
This coding system can complement research on fidelity and may advance research with the goal of understanding the impact of modifications made when evidence-based interventions are implemented. Such findings can further inform efforts to implement such interventions while preserving desired levels of program or intervention effectiveness.
循证干预措施在实施过程中经常会被修改或调整。可能会对方案进行修改，以满足目标人群的需求，或解决干预措施最初设计的背景与实施背景之间的差异[Addict Behav 2011, 36(6):630-635]。然而，修改是否会损害或增强干预措施的预期效果尚不清楚。理解特定类型修改影响的一个挑战是，没有注意到可能发生的不同类型的变化。一种用于对干预措施和项目实施过程中进行的修改进行分类的系统，可以促进理解在特定背景下进行的修改的性质，以及这些修改对感兴趣结果的影响。
我们开发了一个用于对各种领域和环境中的干预措施和项目进行修改分类的系统。然后，我们对 32 篇已发表的描述在常规护理或社区环境中实施的干预措施的文章中确定的 258 个修改进行了编码。
我们确定了对干预措施内容以及干预措施实施背景的修改。我们确定了 12 种不同类型的内容修改，我们的编码方案还包括对这些修改进行分级的评级（从个体患者级别到医院网络或社区级别）。我们确定了五种类型的背景修改（改变干预措施的形式、环境或患者群体，但本身不会改变干预措施的实际内容）。我们还开发了用于表示谁进行了修改的代码，并确定了一小部分对实施循证干预措施时培训或评估方式进行修改的内容。评分者一致性分析表明，该编码方案可用于可靠地对研究文章中描述的修改进行分类，而无需进行过于繁琐的培训。
该编码系统可以补充对保真度的研究，并有助于研究理解实施循证干预措施时进行的修改的影响。这些发现可以进一步为实施这些干预措施的努力提供信息，同时保持项目或干预措施的预期效果水平。
