Telethon Kids Institute, The University of Western Australia, Perth, Australia.
Division of Pediatrics, School of Medicine, The University of Western Australia, Perth, Australia.
Int J Behav Nutr Phys Act. 2023 Jun 1;20(1):65. doi: 10.1186/s12966-023-01457-7.
Adaptations for scale-up are ubiquitous but are rarely described in detail. Adaptations may be a key reason for the "scale-up penalty" which is when there is a reduction in intervention effect size following scale-up. The Play Active intervention consists of a physical activity policy for early childhood education and care (ECEC) services, with accompanying implementation support strategies. It was first implemented with 81 ECEC services in Perth, Western Australia, in 2021 - with significant positive changes in physical activity practice uptake. The aim of this paper is to describe the extent, type, fidelity consistency, goals, size, scope, and proposed impact of proposed adaptations to the implementation support strategies for scaling-up Play Active.
Proposed adaptations were defined as planned changes, made prior to making the intervention available. The authors created a list of adaptations from a comparison of the Play Active implementation support strategies, before and after adaptation for proposed statewide availability across Western Australia, Queensland and South Australia, Australia. We used the Framework for Reporting Adaptations and Modifications-Enhanced Implementation Strategies (FRAME-IS) to code adaptations to implementation support strategies. Three authors coded each adaptation and rated their size, scope and proposed impact.
Fifty-three adaptations to Play Active were identified. Most (68%) were proposed for the 'content' of implementation strategies, including aspects of their delivery. In practice, this involved changing the delivery mode of implementation support strategies from phone call and email support, to website-based delivery. More than half (56%) of adaptations involved 'adding elements' for scale-up. Most adaptations were 'fidelity consistent' (95%). The main goals for adaptations were related to 'increasing the acceptability, appropriateness, or feasibility' (45%), 'decreasing the costs' (19%) and 'increasing adoption of the evidence-based practice' (19%). Adaptations were small to medium in size, with most proposed to have a positive (87%) or neutral (8%) effect on the effectiveness of the intervention, rather than negative (4%).
A large number of small, fidelity-consistent, adaptations were proposed for Play Active scale-up. Overall, the process of reporting adaptations was found to be feasible. To understand the impact of these adaptations, it will be important to re-evaluate implementation, effectiveness and process outcomes, at-scale.
适应性调整无处不在，但很少有详细描述。适应性调整可能是“规模扩大惩罚”的一个关键原因，即干预效果大小在扩大规模后会降低。Play Active 干预措施包括为幼儿教育和保育（ECEC）服务制定的体育活动政策，以及配套的实施支持策略。它于 2021 年首次在澳大利亚西澳大利亚州的 81 个 ECEC 服务中实施，在体育活动实践方面取得了显著的积极变化。本文的目的是描述为扩大 Play Active 规模而对实施支持策略进行调整的程度、类型、保真一致性、目标、规模、范围和拟议影响。
拟议的调整是指在提供干预措施之前计划的更改。作者通过比较 Play Active 实施支持策略，在澳大利亚西澳大利亚州、昆士兰州和南澳大利亚州全州推广之前和之后，为每个拟议的适应性调整创建了一个清单。我们使用报告适应性调整和修改增强实施策略（FRAME-IS）的框架来对实施支持策略进行编码。三位作者对每项适应性调整进行了编码，并对其规模、范围和拟议影响进行了评级。
确定了 53 项对 Play Active 的调整。其中大部分（68%）是针对实施策略的“内容”提出的，包括其实施方式的各个方面。实际上，这涉及将实施支持策略的交付模式从电话和电子邮件支持改为基于网站的交付。超过一半（56%）的调整涉及规模扩大的“添加元素”。大多数调整都是“保真一致”（95%）。调整的主要目标是与“提高可接受性、适当性或可行性”（45%）、“降低成本”（19%）和“提高证据实践的采用”（19%）有关。调整规模较小到中等，大多数调整预计对干预效果产生积极（87%）或中性（8%）影响，而不是消极（4%）影响。
为 Play Active 扩大规模提出了大量小而保真一致的适应性调整。总体而言，报告适应性调整的过程被发现是可行的。为了了解这些适应性调整的影响，在大规模实施时，重新评估实施、效果和过程结果将非常重要。
