Reyes Breanna J, Tinoco Calvillo Stephenie, Lomeli Angel, Escoto Arleth A, Burola Maria Linda, Cain Kelli L, Salgin Linda, Balbuena-Bojorquez Maria, Engler Anne-Marie, Seifert Marva, Laurent Louise C, Stadnick Nicole A, Rabin Borsika A
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, United States.
Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States.
Front Health Serv. 2025 Apr 7;5:1408940. doi: 10.3389/frhs.2025.1408940. eCollection 2025.
Adaptations are expected when complex public health interventions are implemented in dynamically and rapidly changing real-world settings, as seen for many programs during the COVID-19 pandemic. Systematic documentation of adaptations to intervention components and strategies are critical when assessing their impact on implementation. Here, we report processes used for tracking and evaluating adaptations made during the CO-CREATE project, which aimed to address COVID-19 testing disparities in the San Ysidro US/Mexico border community.
The study utilized a longitudinal, prospective, mixed methods approach to systematically document and assess adaptations across the pre-implementation, early and mid/late-implementation phases of the project. Aggregated from a combination of sources (i.e., meeting notes, Advisory Board transcripts, and periodic reflections), adaptations were entered weekly into an electronic database that captured information on 16 characteristics and were validated by study staff. The impacts of the adaptations were determined using a team consensus approach and based on the outcomes from the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Each adaptation was evaluated to determine whether it increased, decreased, had no effect, or not applicable to the RE-AIM outcomes. Data were analyzed using descriptive statistics.
98 adaptations were identified, and most were identified by research staff ( = 79, 75.2%). Planned adaptations were defined as those discussed between at least two research team members prior to implementation. Unplanned adaptations were defined as a change made without shared discussion and agreement among at least 2 research team members. Most adaptations were planned ( = 93, 94.9%). Of those that were planned, ( = 21, 22.6%) occurred during pre-implementation, ( = 26, 28.0%) during early implementation, and ( = 46, 49.4%) during mid/late implementation. Of those that were unplanned, ( = 1, 20.0%) occurred during pre-implementation and ( = 4, 80.0%) occurred during implementation. Most adaptations ( = 45, 45.9%) had a positive impact (i.e., increase) on the efficiency of delivery of services, meaningful engagement of partners, and reach of community members through the program.
This work describes our systematic and prospective approach to document and analyze adaptations over a two-year period and assesses the impact of these adaptations. Lessons learned from this work can be used to develop best practices for adapting interventions to ensure sustainable implementation and address disparities in public health and clinical programs.
在动态且迅速变化的现实环境中实施复杂的公共卫生干预措施时，预计会出现调整，就像新冠疫情期间许多项目所呈现的那样。在评估干预措施对实施的影响时，系统记录对干预组成部分和策略的调整至关重要。在此，我们报告了在CO-CREATE项目期间用于跟踪和评估所做调整的过程，该项目旨在解决美国/墨西哥边境圣伊西德罗社区的新冠病毒检测差异问题。
本研究采用纵向、前瞻性、混合方法，系统记录和评估项目实施前、实施早期以及实施中期/后期阶段的调整情况。从多种来源（即会议记录、咨询委员会记录和定期反思）汇总而来的调整情况，每周录入一个电子数据库，该数据库记录了16项特征信息，并由研究人员进行验证。调整的影响通过团队共识方法并依据“覆盖、效果、采纳、实施和维持”（RE-AIM）框架的结果来确定。对每项调整进行评估，以确定其对RE-AIM结果是增加、减少、无影响还是不适用。使用描述性统计方法对数据进行分析。
共识别出98项调整，其中大部分由研究人员识别（n = 79，75.2%）。计划内调整被定义为至少两名研究团队成员在实施前讨论过的调整。计划外调整被定义为未经至少两名研究团队成员共同讨论和商定而做出的改变。大多数调整是计划内的（n = 93，94.9%）。在计划内调整中，21项（22.6%）发生在实施前，26项（28.0%）发生在实施早期，46项（49.4%）发生在实施中期/后期。在计划外调整中，1项（20.0%）发生在实施前，4项（80.0%）发生在实施期间。大多数调整（n = 45，45.9%）对服务提供效率、合作伙伴的有意义参与以及通过该项目接触社区成员产生了积极影响（即增加）。
这项工作描述了我们在两年期间记录和分析调整情况的系统且前瞻性的方法，并评估了这些调整的影响。从这项工作中吸取的经验教训可用于制定调整干预措施的最佳实践，以确保可持续实施并解决公共卫生和临床项目中的差异问题。
