Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark.
Department of Public Health, Nursing, Aarhus University, Nordre Ringgade 1, 8000, Aarhus, Denmark.
BMC Health Serv Res. 2021 Oct 16;21(1):1108. doi: 10.1186/s12913-021-07142-4.
There is a long-standing debate in implementation research on whether adaptations to evidence-based interventions (EBIs) are desirable in health care. If an intervention is adapted and not delivered as conceived and planned, it is said to have low fidelity. The WALK-Cph project was developed based on the assumption that involving stakeholders in co-design processes would facilitate the fidelity of an intervention to increase the mobility of acutely admitted older medical patients and its implementation in two hospitals in Denmark. The purpose of this study is to describe and analyse adaptations and modifications that were made to the co-designed WALK-Cph intervention and its implementation.
This study used a qualitative design. An ethnographic field study was performed using participant observations, workshops and semi-structured interviews. Data were analysed twice using the Framework Method. The first analysis was based on the frameworks from Stirman, Moore and Proctor. The second analysis, a retrospective modifications analysis, was based on the Adaptation-Impact Framework.
Many different types of adaptations and modifications were made to the WALK-Cph intervention and its implementation plan. Most of the modifications were made on the contents of the intervention. In total, 44 adaptations and modifications were made, of which 21 were planned (adaptations) and 23 were made haphazardly (modifications). Most of the content and context adaptations and modifications made on the intervention had a mixed result regarding enhanced fidelity. The retrospective modifications analysis showed that modifications were ongoing and both situationally and contextually shaped.
Although an extensive co-design process was carried out to facilitate the fidelity of the WALK-Cph intervention, this study showed that many adaptations and modifications were still made to both the intervention and its implementation plan. It could indicate that the co-design process had a small effect or that adaptations and modifications are ongoing and both situationally and contextually shaped, which challenge the assumption and the desire to be able to plan and control changes.
在实施研究中，关于是否需要对基于证据的干预措施（EBIs）进行调整存在长期争议。如果干预措施进行了调整，没有按照设想和计划实施，则认为其保真度低。WALK-Cph 项目的开发基于这样一种假设，即让利益相关者参与共同设计过程将有助于干预措施的保真度，从而提高丹麦两家医院急性入院老年患者的活动能力及其实施效果。本研究的目的是描述和分析对共同设计的 WALK-Cph 干预措施及其实施所进行的调整和修改。
本研究采用定性设计。使用参与观察、研讨会和半结构化访谈进行了一项民族志现场研究。使用框架方法进行了两次数据分析。第一次分析基于 Stirman、Moore 和 Proctor 的框架。第二次分析，即回顾性修改分析，基于适应影响框架。
对 WALK-Cph 干预措施及其实施计划进行了许多不同类型的调整和修改。干预措施的内容进行了大多数修改。总共进行了 44 次调整和修改，其中 21 次是计划内的（调整），23 次是随意进行的（修改）。对干预措施进行的大多数内容和环境调整和修改在提高保真度方面效果不一。回顾性修改分析表明，修改仍在继续，并且是情境和上下文驱动的。
尽管进行了广泛的共同设计过程以促进 WALK-Cph 干预措施的保真度，但本研究表明，对干预措施及其实施计划仍进行了许多调整和修改。这可能表明共同设计过程的效果较小，或者调整和修改仍在继续，并且是情境和上下文驱动的，这挑战了能够计划和控制变更的假设和愿望。
