Movsisyan A, Arnold L, Copeland L, Evans R, Littlecott H, Moore G, O'Cathain A, Pfadenhauer L, Segrott J, Rehfuess E
Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany.
Pettenkofer School of Public Health, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany.
Health Res Policy Syst. 2021 Feb 5;19(1):13. doi: 10.1186/s12961-020-00668-9.
Implementing evidence-informed population health interventions in new contexts often requires adaptations. While the need to adapt interventions to better fit new contexts is recognised, uncertainties remain regarding why and when to adapt (or not), and how to assess the benefits (or not) of adaptation. The ADAPT Study aims to develop comprehensive guidance on adaptation. This scoping review informs guidance development by mapping and exploring how adaptation has been undertaken in practice, in public health and health services research.
We searched seven databases from January 2000 and October 2018 to identify eligible studies for this scoping review and a related systematic review of adaptation guidance. We mapped the studies of adaptation by coding data from all eligible studies describing the methods, contexts, and interventions considered for adaptation. From this map, we selected a sample of studies for in-depth examination. Two reviewers extracted data independently into seven categories: description, key concepts, types, rationale, processes, evaluation methods, evaluation justification, and accounts of failures and successes.
We retrieved 6694 unique records. From 429 records screened at full text, we identified 298 eligible studies for mapping and selected 28 studies for in-depth examination. The majority of studies in our map focused on micro- (i.e., individual-) level interventions (84%), related to transferring an intervention to a new population group within the same country (62%) and did not report using guidance (73%). Studies covered a range of topic areas, including health behaviour (24%), mental health (19%), sexual health (16%), and parenting and family-centred interventions (15%). Our in-depth analysis showed that adaptation is seen to save costs and time relative to developing a new intervention, and to enhance contextual relevance and cultural compatibility. It commonly follows a structured process and involves stakeholders to help with decisions on what to adapt, when, and how.
Adaptation has been undertaken on a range of health topics and largely in line with existing guidance. Significant gaps relate to adaptation of macro- (e.g., national-) level interventions, consideration of programme theories, mechanisms and contexts (i.e., a functional view of interventions), nuances around stakeholder involvement, and evaluation of the adapted interventions. Registration Open Science Framework, 2019, osf.io/udzma.
在新环境中实施基于证据的人群健康干预措施通常需要进行调整。虽然人们认识到需要调整干预措施以更好地适应新环境，但对于为何以及何时进行调整（或不调整），以及如何评估调整的益处（或没有益处）仍存在不确定性。ADAPT研究旨在制定关于调整的全面指南。本范围综述通过梳理和探索公共卫生与卫生服务研究实践中如何进行调整，为指南制定提供参考。
我们检索了2000年1月至2018年10月期间的七个数据库，以确定符合本范围综述及相关调整指南系统综述要求的研究。我们通过对所有符合条件的研究数据进行编码，梳理了有关调整的研究，这些数据描述了所考虑的调整方法、环境和干预措施。基于此梳理结果，我们选取了一部分研究进行深入审查。两名审查员独立将数据提取到七个类别中：描述、关键概念、类型、理论依据、过程、评估方法、评估理由以及成败案例。
我们检索到6694条独特记录。在对429条全文筛选记录进行筛选后，我们确定了298项符合条件的研究用于梳理，并选取了28项研究进行深入审查。我们梳理的研究中，大多数聚焦于微观（即个体）层面的干预措施（84%），涉及将一项干预措施应用于同一国家内的新人群组（62%），且未报告使用了指南（73%）。研究涵盖了一系列主题领域，包括健康行为（24%）、心理健康（19%）、性健康（16%）以及育儿和以家庭为中心的干预措施（15%）。我们的深入分析表明，与开发新的干预措施相比，调整被认为可以节省成本和时间，并增强情境相关性和文化兼容性。它通常遵循一个结构化的过程，并且会让利益相关者参与进来，以帮助决定调整什么、何时调整以及如何调整。
在一系列健康主题上都进行了调整，且在很大程度上符合现有指南。显著的差距涉及宏观（如国家）层面干预措施的调整、对项目理论、机制和环境（即干预措施的功能视角）的考虑、利益相关者参与的细微差别以及对调整后干预措施的评估。注册 开放科学框架，2019，osf.io/udzma。
