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. 2020 Jul 20;15(1):56.
doi: 10.1186/s13012-020-01021-y.

Towards a comprehensive model for understanding adaptations' impact: the model for adaptation design and impact (MADI)

M Alexis Kirk  1 , Julia E Moore  2 , Shannon Wiltsey Stirman  3 , Sarah A Birken  4
Affiliations

Towards a comprehensive model for understanding adaptations' impact: the model for adaptation design and impact (MADI)

M Alexis Kirk et al. Implement Sci. .

Abstract

Background: Implementation science is shifting from qualifying adaptations as good or bad towards understanding adaptations and their impact. Existing adaptation classification frameworks are largely descriptive (e.g., who made the adaptation) and geared towards researchers. They do not help practitioners in decision-making around adaptations (e.g., is an adaptation likely to have negative impacts? Should it be pursued?). Moreover, they lack constructs to consider "ripple effects" of adaptations (i.e., both intended and unintended impacts on outcomes, recognizing that an adaptation designed to have a positive impact on one outcome may have unintended impacts on other outcomes). Finally, they do not specify relationships between adaptations and outcomes, including mediating and moderating relationships. The objective of our research was to promote systematic assessment of intended and unintended impacts of adaptations by using existing frameworks to create a model that proposes relationships among constructs.

Materials and methods: We reviewed, consolidated, and refined constructs from two adaptation frameworks and one intervention-implementation outcome framework. Using the consolidated and refined constructs, we coded qualitative descriptions of 14 adaptations made to an existing evidence-based intervention; the 14 adaptations were designed in prior research by a stakeholder panel using a modified Delphi approach. Each of the 14 adaptations had detailed descriptions, including the nature of the adaptation, who made it, and its goal and reason. Using coded data, we arranged constructs from existing frameworks into a model, the Model for Adaptation Design and Impact (MADI), that identifies adaptation characteristics, their intended and unintended impacts (i.e., ripple effects), and potential mediators and moderators of adaptations' impact on outcomes. We also developed a decision aid and website ( MADIguide.org ) to help implementation scientists apply MADI in their work.

Results and conclusions: Our model and associated decision aids build on existing frameworks by comprehensively characterizing adaptations, proposing how adaptations impact outcomes, and offering practical guidance for designing adaptations. MADI encourages researchers to think about potential causal pathways of adaptations (e.g., mediators and moderators) and adaptations' intended and unintended impacts on outcomes. MADI encourages practitioners to design adaptations in a way that anticipates intended and unintended impacts and leverages best practice from research.

Keywords: Adaptation; Evidence-based intervention; Implementation outcomes.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Model for Adaptation Design and Impact (MADI)
Fig. 2
Fig. 2
Decision-making guide for prospective use of MADI
Fig. 3
Fig. 3
Retrospective application of MADI
See this image and copyright information in PMC

References

    1. Moore JE, Bumbarger BK, Cooper BR. Examining adaptations of evidence-based programs in natural contexts. J Prim Prev. 2013;34(3):147–161. doi: 10.1007/s10935-013-0303-6. - DOI - PubMed
    1. Stirman SW, Baumann AA, Miller CJ. The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implement Sci. 2019;14(1):58. doi: 10.1186/s13012-019-0898-y. - DOI - PMC - PubMed
    1. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health Ment Health Serv Res. 2011;38(2):65–76. doi: 10.1007/s10488-010-0319-7. - DOI - PMC - PubMed
    1. Castro FG, Barrera M, Martinez CR. The cultural adaptation of prevention interventions: resolving tensions between fidelity and fit. Prev Sci. 2004;5(1):41–45. doi: 10.1023/B:PREV.0000013980.12412.cd. - DOI - PubMed
    1. Lee SJ, Altschul I, Mowbray CT. Using planned adaptation to implement evidence-based programs with new populations. Am J Community Psychol. 2008;41(3-4):290–303. doi: 10.1007/s10464-008-9160-5. - DOI - PubMed

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